CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme

Southern African Journal of HIV Medicine

Field Value
Title CD4 testing after initiation of antiretroviral therapy: Analysis of routine data from the South African HIV programme
Creator Lilian, Rivka R. Davies, Natasha Gilbert, Louise McIntyre, James A. Struthers, Helen E. Rees, Kate
Subject Public Health CD4; HIV; South Africa; advanced clinical care; immunological non-responder; TIER.Net
Description Background: People living with HIV (PLHIV) who have low CD4 counts require advanced clinical care (ACC) to minimise morbidity and mortality risk. These patients include immunological non-responders (INRs) with low CD4 counts despite a suppressed viral load.Objectives: To determine the proportion of patients with low CD4 counts after antiretroviral therapy (ART) initiation and to describe INRs within that group.Methods: Routine Three Interlinked Electronic Registers.Net (TIER.Net) data from four South African districts were analysed for adult PLHIV on ART 12 months. Immunological non-responders were defined as patients on ART 4 years who were virally suppressed (viral load 1000 copies/mL) with a CD4 count ≤ 350 cell/mm3.Results: Baseline CD4 was recorded for 80.9% of the 869 571 patients newly initiating ART, with 37.2% of those starting ART since 2017 having baseline counts ≤ 200 cells/mm3. Amongst all 1 178 190 patients on ART, only 46.5% had a CD4 test after ART initiation and of these, 14.3% had CD4 ≤ 200 cells/mm3. This proportion was highest amongst patients on ART ≤ 2 years (19.7%) (p 0.001). Amongst virally suppressed patients, 20.0% were INRs. Immunological non-response was significantly more likely amongst patients on second-line ART (adjusted odds ratio [aOR] 1.79), those aged 35-45 and ≥ 45 years (aOR 1.15 and 1.50, respectively), males (aOR 2.28) and patients with confirmed TB (aOR 2.49), and was significantly less likely in cases with higher baseline CD4 count (aOR 0.35).Conclusion: CD4 testing subsequent to ART initiation is poorly implemented and there is a notable proportion of patients with low CD4 counts. Guidelines regarding CD4 testing and ACC need to be more widely implemented to identify patients with low CD4 counts and improve their outcomes.
Publisher AOSIS
Contributor US President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID)
Date 2020-12-14
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — —
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajhivmed.v21i1.1165
Source Southern African Journal of HIV Medicine; Vol 21, No 1 (2020); 4 pages 2078-6751 1608-9693
Language eng
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Coverage South Africa — —
Rights Copyright (c) 2020 Rivka R. Lilian, Natasha Davies, Louise Gilbert, James A. McIntyre, Helen E. Struthers, Kate Rees