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Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa

OBJECTIVES: Understanding of progression to antiretroviral therapy (ART) eligibility and associated factors remains limited. The objectives of this analysis were to determine the time to ART eligibility and to explore factors associated with disease progression in adults with early HIV infection. ME...

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Detalles Bibliográficos
Autores principales: McGrath, N, Lessells, RJ, Newell, ML
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682449/
https://www.ncbi.nlm.nih.gov/pubmed/25959724
http://dx.doi.org/10.1111/hiv.12255
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author McGrath, N
Lessells, RJ
Newell, ML
author_facet McGrath, N
Lessells, RJ
Newell, ML
author_sort McGrath, N
collection PubMed
description OBJECTIVES: Understanding of progression to antiretroviral therapy (ART) eligibility and associated factors remains limited. The objectives of this analysis were to determine the time to ART eligibility and to explore factors associated with disease progression in adults with early HIV infection. METHODS: HIV-infected adults (≥ 18 years old) with CD4 cell count > 500 cells/μl were enrolled in the study at three primary health care clinics, and a sociodemographic, behavioural and partnership-level questionnaire was administered. Participants were followed 6-monthly and ART eligibility was determined using a CD4 cell count threshold of 350 cells/μl. Kaplan − Meier and Cox proportional hazard regression modelling were used in the analysis. RESULTS: A total of 206 adults contributed 381 years of follow-up; 79 (38%) reached the ART eligibility threshold. Median time to ART eligibility was shorter for male patients (12.0 months) than for female patients (33.9 months). Male sex [adjusted hazard ratio (aHR) 3.13; 95% confidence interval (CI) 1.82–5.39], residing in a household with food shortage in the previous year (aHR 1.58; 95% CI 0.99–2.54), and taking nutritional supplements in the first 6 months after enrolment (aHR 2.06; 95% CI 1.11–3.83) were associated with shorter time to ART eligibility. Compared with reference CD4 cell count ≤  559 cells/μl, higher CD4 cell count was associated with longer time to ART eligibility [aHR 0.46 (95% CI 0.25–0.83) for CD4 cell count 560–632 cells/μl; aHR 0.30 (95% CI 0.16–0.57) for CD4 cell count 633–768 cells/μl; and aHR 0.17 (95% CI 0.08–0.38) for CD4 cell count > 768 cells/μl]. CONCLUSIONS: Over one in three adults with CD4 cell count > 500 cells/μl became eligible for ART at a CD4 cell count threshold of 350 cells/μl over a median of 2 years. The shorter time to ART eligibility in male patients suggests a possible need for sex-specific pre-ART care and monitoring strategies.
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spelling pubmed-46824492015-12-23 Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa McGrath, N Lessells, RJ Newell, ML HIV Med Short Communication OBJECTIVES: Understanding of progression to antiretroviral therapy (ART) eligibility and associated factors remains limited. The objectives of this analysis were to determine the time to ART eligibility and to explore factors associated with disease progression in adults with early HIV infection. METHODS: HIV-infected adults (≥ 18 years old) with CD4 cell count > 500 cells/μl were enrolled in the study at three primary health care clinics, and a sociodemographic, behavioural and partnership-level questionnaire was administered. Participants were followed 6-monthly and ART eligibility was determined using a CD4 cell count threshold of 350 cells/μl. Kaplan − Meier and Cox proportional hazard regression modelling were used in the analysis. RESULTS: A total of 206 adults contributed 381 years of follow-up; 79 (38%) reached the ART eligibility threshold. Median time to ART eligibility was shorter for male patients (12.0 months) than for female patients (33.9 months). Male sex [adjusted hazard ratio (aHR) 3.13; 95% confidence interval (CI) 1.82–5.39], residing in a household with food shortage in the previous year (aHR 1.58; 95% CI 0.99–2.54), and taking nutritional supplements in the first 6 months after enrolment (aHR 2.06; 95% CI 1.11–3.83) were associated with shorter time to ART eligibility. Compared with reference CD4 cell count ≤  559 cells/μl, higher CD4 cell count was associated with longer time to ART eligibility [aHR 0.46 (95% CI 0.25–0.83) for CD4 cell count 560–632 cells/μl; aHR 0.30 (95% CI 0.16–0.57) for CD4 cell count 633–768 cells/μl; and aHR 0.17 (95% CI 0.08–0.38) for CD4 cell count > 768 cells/μl]. CONCLUSIONS: Over one in three adults with CD4 cell count > 500 cells/μl became eligible for ART at a CD4 cell count threshold of 350 cells/μl over a median of 2 years. The shorter time to ART eligibility in male patients suggests a possible need for sex-specific pre-ART care and monitoring strategies. John Wiley & Sons, Ltd 2015-09 2015-05-11 /pmc/articles/PMC4682449/ /pubmed/25959724 http://dx.doi.org/10.1111/hiv.12255 Text en © 2015 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association. http://creativecommons.org/licenses/by/4.0/ This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Short Communication
McGrath, N
Lessells, RJ
Newell, ML
Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa
title Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa
title_full Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa
title_fullStr Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa
title_full_unstemmed Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa
title_short Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa
title_sort time to eligibility for antiretroviral therapy in adults with cd4 cell count > 500 cells/μl in rural kwazulu-natal, south africa
topic Short Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682449/
https://www.ncbi.nlm.nih.gov/pubmed/25959724
http://dx.doi.org/10.1111/hiv.12255
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