Global trends in CD4 count measurement and distribution at first antiretroviral treatment initiation.

Autor:	de Waal R; Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa. CIDER, Level 3 Falmouth Building, Anzio Road, Observatory, 7925, South Africa., Wools-Kaloustian K; Department of Medicine, Indiana University School of Medicine, USA., Brazier E; Institute for Implementation Science in Population Health, City University of New York, USA., Althoff KN; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, USA., Jaquet A; National Institute for Health and Medical Research UMR 1219, Research Institute for Sustainable Development EMR 271, Bordeaux Population Health Research Centre, University of Bordeaux, France., Duda SN; Department of Biomedical Informatics, Vanderbilt University Medical Center, USA., Kumarasamy N; Infectious Diseases Medical Centre, CART CRS, Voluntary Health Services, Chennai, India., Savory T; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia., Byakwaga H; Department of Community Health, Mbarara University of Science and Technology, Uganda., Murenzi G; Research for Development (RD Rwanda), and Rwanda Military Referral and Teaching Hospital, Kigali, Rwanda., Justice A; VA Connecticut Healthcare System, Yale Schools of Medicine and Public Health, Yale University, USA., Ekouevi DK; Université de Lomé, Centre de Formation et de Recherche en Santé Publique, Lomé, Togo., Cesar C; Fundacion Huesped, Argentina., Pasayan MKU; Research Institute for Tropical Medicine, Muntinlupa City, Philippines., Thawani A; Lighthouse Trust, Lilongwe, Malawi., Kasozi C; Masaka Regional Referral Hospital, Masaka City, Uganda., Babakazo P; Kinshasa School of Public Health, University of Kinshasa, Democratic Republic of Congo., Karris M; Department of Medicine, University of California San Diego, USA., Messou E; Centre de Prise en charge, de Recherche et de Formation (CePReF) Yopougon-Attié, Abidjan, Côte d'Ivoire., Cortes CP; Department of Internal Medicine, Faculty of Medicine, University of Chile, and Hospital Clínico San Borja Arriarán & Fundación Arriarán, Santiago, Chile., Kunzekwenyika C; SolidarMed  Zimbabwe., Choi JY; Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea., Owarwo NC; Infectious Diseases Institute, Makerere University, Uganda., Niyongabo A; Association Nationale de Soutien aux Séropositifs et malades du SIDA-Santé PLUS (ANSS-Santé PLUS), Burundi., Marconi VC; Emory University School of Medicine and Rollins School of Public Health, Atlanta, USA., Ezechi O; Centre for Reproduction and Population Health Studies, Nigerian Institute for Medical Research, Lagos, Nigeria., Castilho JL; Division of Infectious Diseases, Vanderbilt University Medical Center, TN, USA., Petoumenos K; The Kirby Institute, University of New South Wales, Sydney, Australia., Johnson L; Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa. CIDER, Level 3 Falmouth Building, Anzio Road, Observatory, 7925, South Africa., Ford N; Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa. CIDER, Level 3 Falmouth Building, Anzio Road, Observatory, 7925, South Africa.; Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland., Kassanjee R; Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, South Africa. CIDER, Level 3 Falmouth Building, Anzio Road, Observatory, 7925, South Africa.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2024 Nov 06. Date of Electronic Publication: 2024 Nov 06.
DOI:	10.1093/cid/ciae548
Abstrakt:	Background: While people with HIV (PWH) start antiretroviral treatment (ART) regardless of CD4 count, CD4 measurement remains crucial for detecting advanced HIV disease and evaluating ART programmes. We explored CD4 measurement (proportion of PWH with a CD4 result available) and prevalence of CD4 <200 cells/µL at ART initiation within the International epidemiology Databases to Evaluate AIDS (IeDEA) global collaboration. Methods: We included PWH at participating ART programmes who first initiated ART at age 15-80 years during 2005-2019. We described proportions of PWH (i) with CD4 (measured within 6 months before to 2 weeks after ART initiation); and (ii) among those with a CD4, with CD4 <200; by year of ART initiation and region. Results: We included 1,355,104 PWH from 42 countries in 7 regions; 63% were female. Median (interquartile range) age at ART initiation was 37 (31-44) in men and 32 (26-39) in women. CD4 measurement initially increased, or remained stable over time until around 2013, but then declined to low levels in some regions (Southern Africa, except South Africa: from 54 to 13%; East Africa 85 to 31%; Central Africa 72 to 20%; West Africa: 91 to 53%; and Latin America: 87 to 56%). Prevalence of CD4<200 declined over time in all regions, but plateaued after 2015 at ≥30%. Conclusions: CD4 measurement has declined sharply in recent years, especially in sub-Saharan Africa. Among those with a CD4, the prevalence of CD4 <200 remains concerningly high. Scaling up CD4 testing and securing adequate funding are urgent priorities. (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze:	MEDLINE
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