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

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases Pub Date : 2024-11-06 DOI:10.1093/cid/ciae548

Reneé de Waal, Kara Wools-Kaloustian, Ellen Brazier, Keri N Althoff, Antoine Jaquet, Stephany N Duda, Nagalingeswaran Kumarasamy, Theodora Savory, Helen Byakwaga, Gad Murenzi, Amy Justice, Didier K Ekouevi, Carina Cesar, Mark K U Pasayan, Agness Thawani, Charles Kasozi, Pelagie Babakazo, Maile Karris, Eugene Messou, Claudia P Cortes, Cordelia Kunzekwenyika, Jun Yong Choi, Noela C Owarwo, Annabelle Niyongabo, Vincent C Marconi, Oliver Ezechi, Jessica L Castilho, Kathy Petoumenos, Leigh Johnson, Nathan Ford, Reshma Kassanjee

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引用次数: 0

Abstract

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.

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首次开始抗逆转录病毒治疗时 CD4 细胞计数测量和分布的全球趋势。

背景：尽管艾滋病病毒感染者（PWH）开始接受抗逆转录病毒治疗（ART）时不考虑 CD4 细胞计数，但 CD4 测量对于检测晚期艾滋病病毒感染和评估抗逆转录病毒治疗计划仍然至关重要。我们探讨了 CD4 测量（有 CD4 检测结果的感染者比例）和 CD4 方法的流行情况：我们纳入了 2005-2019 年间参与抗逆转录病毒疗法项目、首次开始抗逆转录病毒疗法年龄在 15-80 岁之间的感染者。我们描述了以下人群的比例：(i) 有 CD4（开始抗逆转录病毒疗法前 6 个月至开始抗逆转录病毒疗法后 2 周内测量）；(ii) 在有 CD4 的人群中，有 CD4 结果的人群：我们纳入了来自 7 个地区 42 个国家的 1,355,104 名艾滋病感染者；其中 63% 为女性。开始接受抗逆转录病毒疗法时的中位年龄（四分位数间距）男性为 37（31-44）岁，女性为 32（26-39）岁。CD4 测量值最初有所上升，或在 2013 年前后保持稳定，但随后在一些地区降至较低水平（南部非洲（南非除外）：从 54% 降至 13%；东非：从 85% 降至 31%；中非：从 72% 降至 20%；西非：从 91% 降至 53%；拉丁美洲：从 87% 降至 56%）。CD4 发病率：近年来，CD4检测率急剧下降，尤其是在撒哈拉以南非洲地区。在有 CD4 检测结果的人群中，CD4

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来源期刊

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.