Abstract:
Abstract
Background—Few data are available on the long-term immunologic response to ART in resourcelimited
settings, where antiretroviral therapy (ART) is being scaled up using a public health approach,
with a limited repertoire of drugs.
Objectives—To describe immunologic response to ART in a network of cohorts from sub-Saharan
Africa, Latin America, and Asia.
Study population/methods—Treatment-naïve patients aged 15 and older from 27 treatment
programs were eligible. Multi-level, linear mixed models were used to assess associations between
predictor variables and CD4 count trajectories following ART initiation.
Correspondence to: Denis Nash, PhD, MPH, Columbia University, Mailman School of Public Health, International Center for AIDS
Care and Treatment Programs (ICAP), 722 W. 168th St., Room 706, New York, NY 10032 USA, dn2145@columbia.edu, Phone:
+1-718-530-0684, Fax: +1-360-851-7175.
Writing Committee
Denis Nash, Monica Katyal, Martin W.G. Brinkhof, Olivia Keiser, Margaret May, Rachael Hughes, Francois Dabis, Robin Wood,
Eduardo Sprinz, Mauro Schechter, Matthias Egger for the ART-LINC Collaboration of IeDEA
Central Coordinating Team
Martin Brinkhof, Eric Balestre, Claire Graber (project manager), Catherine Seyler, Hapsatou Touré, François Dabis (principal
investigator), Matthias Egger (principal investigator), Mauro Schechter (principal investigator).
Steering committee
Kathryn Anastos (Kigali); David Bangsberg (Mbarara/Kampala); Andrew Boulle (Cape Town); Jennipher Chisanga (Lusaka); Eric
Delaporte (Dakar); Diana Dickinson (Gaborone); Ernest Ekong (Lagos); Kamal Marhoum El Filali (Casablanca); Mina Hosseinipour
(Lilongwe); Charles Kabugo (Kampala); Silvester Kimaiyo (Eldoret); Mana Khongphatthanayothin (Bangkok); N Kumarasamy
(Chennai); Christian Laurent (Yaounde); Ruedi Luthy (Harare); James McIntyre (Johannesburg); Timothy Meade (Lusaka); Eugene
Messou (Abidjan); Denis Nash (New York); Winstone Nyandiko Mokaya (Eldoret); Margaret Pascooe (Harare); Larry Pepper (Mbarara);
Papa Salif Sow (Dakar); Sam Phiri (Lilongwe); Mauro Schechter (Rio de Janeiro); John Sidle (Eldoret); Eduardo Sprinz (Porto Alegre);
Besigin Tonwe-Gold (Abidjan); Siaka Touré (Abidjan); Stefaan Van der Borght (Amsterdam); Ralf Weigel (Lilongwe); Robin Wood
(Cape Town).
Participating centers
Service des Maladies Infectieuses, Casablanca, Maroc; Moi Teaching and Referral Hospital, Eldoret, Kenya; Immune Suppression
Syndrome clinic, Mbarara, Uganda; Generic Antiretroviral Treatment Project, Kampala, Uganda; Centre de Prise en Charge, de Recherche
et de Formation sur le VIH/SIDA (CEPREF), Abidjan, Côte d'Ivoire; ANRS 1215/1290 Study Group, Dakar, Senegal; Independent
Surgery, Gaborone, Botswana; Lighthouse Trust Clinic, Lilongwe, Malawi; Gugulethu ART Programme, Gugulethu, South Africa;
Perinatal HIV Research Unit (PHRU), Soweto, South Africa; Khayelitsha ART Programme, Khayelitsha, South Africa; Helen Joseph
Hospital Themba Lethu Clinic, Johannesburg, South Africa; CorpMed Medical Centre, Lusaka, Zambia; Connaught Clinic, Harare,
Zimbabwe; Prospective Evaluation in the Use and Monitoring of Antiretrovirals in Argentina (PUMA), Buenos Aires, Argentina; Rio
HIV Cohort, Rio de Janeiro, Brazil; South Brazil HIV Cohort (SOBRHIV), Hospital de Clinicas, Porto Alegre, Brazil; YRG Care,
Chennai, India; Thai Red Cross AIDS Research Centre, Bangkok, Thailand; International Center for AIDS Care and Treatment Programs,
MTCT-Plus Initiative, Mailman School of Public Health, Columbia University, New York, USA; Heineken ART Programme,
Amsterdam, The Netherlands.
NIH Public Access
Author Manuscript
AIDS. Author manuscript; available in PMC 2009 December 15.
Published in final edited form as:
AIDS. 2008 November 12; 22(17): 2291–2302. doi:10.1097/QAD.0b013e3283121ca9.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Results—Of 29,175 patients initiating ART, 8,933 patients (31%) were excluded due to insufficient
follow-up time and early lost to follow-up or death. The remaining 19,967 patients contributed 39,200
person-years on ART and 71,067 CD4 measurements. The median baseline CD4 count was 114 cells/
μL, with 35%<100 cells μL and substantial inter-site variation (range: 61-181 cells/μL). Females had
higher median baseline CD4 counts than males (121 vs. 104 cells/μL). The median CD4 count
increased from 114 cells/μL at ART initiation to 230 (IQR:144-338) at 6 months, 263 (IQR:175-376)
at 1 year, 336 (IQR:224-472) at 2 years, 372 (IQR:242-537) at 3 years, 377 (IQR:221-561) at 4 years,
and 395 (IQR:240-592) at 5 years. In multivariable models, baseline CD4 count was the most
important determinant of subsequent CD4 count trajectories.
Conclusions—These data demonstrate robust and sustained CD4 response to ART among patients
remaining on therapy. Public health and programmatic interventions leading to earlier HIV diagnosis
and initiation of ART could substantially improve patient outcomes in resource-limited settings