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Long-term CD4 Response to Potent ART among ART-naïve Patients in Several Low-income Countries
Denis Nash*1, M Katyal1, M Brinkhof2, S Tuboi3, P Braitstein4, E Balestre5, M May6, E Sprinz7, N Kumarasamy8, M Egger2, and The Antiretroviral Theraphy in Low Income Countries (ART-LINC) Collaboration of IEDEA
1Columbia Univ Mailman Sch of Publ Hlth, New York, NY, US; 2Univ of Berne, Switzerland; 3Univ of Pittsburgh, PA, US; 4Indiana Univ Sch of Med, Indianapolis, US; 5Univ Victor Segalen, Bordeaux, France; 6Univ of Bristol, UK; 7Federal Univ of Rio Grande do Sul, Porte Alegre, Brazil; and 8YRGCARE, Chennai, India
Background: Very few data exist on long-term CD4
response to ART in patients from low-income settings. This analysis describes
the temporal change in CD4 count and factors associated with CD4 count response
following ART initiation among cohorts from sub-Saharan Africa, Latin America,
and Asia that are participating in the ART-LINC Collaboration of IEDEA.
Methods: All treatment-naïve adult and adolescent
patients who initiated ART in 1995 or later, with at least 6 months of
follow-up, and at least 2 documented CD4 counts between 31 days prior to and 5
years after ART initiation were included. Variables analyzed were baseline CD4,
clinical stage, age, sex, year of ART initiation, regimen, and site. Linear
mixed models were used to assess associations between independent variables and
CD4 count over time.
Results: Of 24,313 ART-naïve patients, 15,381 (63%)
with the potential for 6 or more months of follow-up were included,
contributing 21,655 person-years on ART and 56,678 CD4 measurements to the
analysis. Excluded patients were more likely to be missing baseline CD4 count
and have initiated ART more recently. The median baseline CD4 count was 108
cells/µL with substantial variation across sites; the rate of CD4 testing was
2.6 tests per person-years on ART. In crude analysis, the median CD4 count at
ART initiation was 108 cells/µL (IQR 45 to 183, n = 13,846), and
increased to 238 (IQR 157 to 347, n = 10,276) at 6 months, 278 (IQR 187
to 394, n = 7,164,) at 12 months, 351 (IQR 235 to 487, n = 2632)
at 24 months, 380 (IQR 253 to 546, n = 1089) at 3 years, 416 (IQR 263 to
578, n = 541) at 4 years, and 442 (IQR 305 to 632, n = 269) at 5
years. In multivariable models, factors that most differentiated CD4 count
trajectories over time were baseline CD4 count (those with lower baseline CD4
had a larger absolute change than those with higher baseline CD4, but a longer
time with CD4 counts <200 cells/µL), age at ART initiation (younger patients
had higher CD4 counts than older patients), and sex (females had greater CD4
counts than males throughout the follow-up period) and site.
Conclusions: These data demonstrate excellent CD4
response to ART among patients from multiple sites in resource-limited
settings. The response is sustained among those remaining on ART as long as 5
years. While this is a select sample of patients with 2 or more CD4 counts
after ART initiation, the data are encouraging for the long-term effectiveness
of ART in resource-limited settings among those who remain on ART.
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