Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa
Identifieur interne : 000094 ( Pmc/Corpus ); précédent : 000093; suivant : 000095Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa
Auteurs : N. Mcgrath ; Rj Lessells ; Ml NewellSource :
- HIV Medicine [ 1464-2662 ] ; 2015.
Abstract
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.
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.
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].
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.
Url:
DOI: 10.1111/hiv.12255
PubMed: 25959724
PubMed Central: 4682449
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PMC:4682449Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa</title><author><name sortKey="Mcgrath, N" sort="Mcgrath, N" uniqKey="Mcgrath N" first="N" last="Mcgrath">N. Mcgrath</name><affiliation><nlm:aff id="au1"><institution>Academic Unit of Primary Care and Population Sciences, University of Southampton</institution><addr-line>Southampton, UK</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au2"><institution>Department of Social Statistics and Demography, University of Southampton</institution><addr-line>Southampton, UK</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au3"><institution>Africa Centre for Health and Population Studies, University of KwaZulu-Natal</institution><addr-line>Mtubatuba, South Africa</addr-line></nlm:aff></affiliation></author><author><name sortKey="Lessells, Rj" sort="Lessells, Rj" uniqKey="Lessells R" first="Rj" last="Lessells">Rj Lessells</name><affiliation><nlm:aff id="au3"><institution>Africa Centre for Health and Population Studies, University of KwaZulu-Natal</institution><addr-line>Mtubatuba, South Africa</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au4"><institution>Department of Clinical Research, London School of Hygiene and Tropical Medicine</institution><addr-line>London, UK</addr-line></nlm:aff></affiliation></author><author><name sortKey="Newell, Ml" sort="Newell, Ml" uniqKey="Newell M" first="Ml" last="Newell">Ml Newell</name><affiliation><nlm:aff id="au2"><institution>Department of Social Statistics and Demography, University of Southampton</institution><addr-line>Southampton, UK</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au3"><institution>Africa Centre for Health and Population Studies, University of KwaZulu-Natal</institution><addr-line>Mtubatuba, South Africa</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au5"><institution>Academic Unit of Human Development and Health, University of Southampton</institution><addr-line>Southampton, UK</addr-line></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25959724</idno><idno type="pmc">4682449</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682449</idno><idno type="RBID">PMC:4682449</idno><idno type="doi">10.1111/hiv.12255</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000094</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000094</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa</title><author><name sortKey="Mcgrath, N" sort="Mcgrath, N" uniqKey="Mcgrath N" first="N" last="Mcgrath">N. Mcgrath</name><affiliation><nlm:aff id="au1"><institution>Academic Unit of Primary Care and Population Sciences, University of Southampton</institution><addr-line>Southampton, UK</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au2"><institution>Department of Social Statistics and Demography, University of Southampton</institution><addr-line>Southampton, UK</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au3"><institution>Africa Centre for Health and Population Studies, University of KwaZulu-Natal</institution><addr-line>Mtubatuba, South Africa</addr-line></nlm:aff></affiliation></author><author><name sortKey="Lessells, Rj" sort="Lessells, Rj" uniqKey="Lessells R" first="Rj" last="Lessells">Rj Lessells</name><affiliation><nlm:aff id="au3"><institution>Africa Centre for Health and Population Studies, University of KwaZulu-Natal</institution><addr-line>Mtubatuba, South Africa</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au4"><institution>Department of Clinical Research, London School of Hygiene and Tropical Medicine</institution><addr-line>London, UK</addr-line></nlm:aff></affiliation></author><author><name sortKey="Newell, Ml" sort="Newell, Ml" uniqKey="Newell M" first="Ml" last="Newell">Ml Newell</name><affiliation><nlm:aff id="au2"><institution>Department of Social Statistics and Demography, University of Southampton</institution><addr-line>Southampton, UK</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au3"><institution>Africa Centre for Health and Population Studies, University of KwaZulu-Natal</institution><addr-line>Mtubatuba, South Africa</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="au5"><institution>Academic Unit of Human Development and Health, University of Southampton</institution><addr-line>Southampton, UK</addr-line></nlm:aff></affiliation></author></analytic><series><title level="j">HIV Medicine</title><idno type="ISSN">1464-2662</idno><idno type="eISSN">1468-1293</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objectives</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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].</p></sec><sec><title>Conclusions</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wandel, S" uniqKey="Wandel S">S Wandel</name></author><author><name sortKey="Egger, M" uniqKey="Egger M">M Egger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lodi, S" uniqKey="Lodi S">S Lodi</name></author><author><name sortKey="Phillips, A" uniqKey="Phillips A">A Phillips</name></author><author><name sortKey="Touloumi, G" uniqKey="Touloumi G">G Touloumi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Langford, Se" uniqKey="Langford S">SE Langford</name></author><author><name sortKey="Ananworanich, J" uniqKey="Ananworanich J">J Ananworanich</name></author><author><name sortKey="Cooper, Da" uniqKey="Cooper D">DA Cooper</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chida, Y" uniqKey="Chida Y">Y Chida</name></author><author><name sortKey="Vedhara, K" uniqKey="Vedhara K">K Vedhara</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ironson, G" uniqKey="Ironson G">G Ironson</name></author><author><name sortKey="Hayward, H" uniqKey="Hayward H">H Hayward</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lessells, Rj" uniqKey="Lessells R">RJ Lessells</name></author><author><name sortKey="Mutevedzi, Pc" uniqKey="Mutevedzi P">PC Mutevedzi</name></author><author><name sortKey="Iwuji, Cc" uniqKey="Iwuji C">CC Iwuji</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcgrath, N" uniqKey="Mcgrath N">N McGrath</name></author><author><name sortKey="Richter, L" uniqKey="Richter L">L Richter</name></author><author><name sortKey="Newell, Ml" uniqKey="Newell M">ML Newell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Houlihan, Cf" uniqKey="Houlihan C">CF Houlihan</name></author><author><name sortKey="Bland, Rm" uniqKey="Bland R">RM Bland</name></author><author><name sortKey="Mutevedzi, Pc" uniqKey="Mutevedzi P">PC Mutevedzi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcgrath, N" uniqKey="Mcgrath N">N McGrath</name></author><author><name sortKey="Richter, L" uniqKey="Richter L">L Richter</name></author><author><name sortKey="Newell, Ml" uniqKey="Newell M">ML Newell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sayles, Jn" uniqKey="Sayles J">JN Sayles</name></author><author><name sortKey="Hays, Rd" uniqKey="Hays R">RD Hays</name></author><author><name sortKey="Sarkisian, Ca" uniqKey="Sarkisian C">CA Sarkisian</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pulerwitz, J" uniqKey="Pulerwitz J">J Pulerwitz</name></author><author><name sortKey="Barker, G" uniqKey="Barker G">G Barker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lessells, Rj" uniqKey="Lessells R">RJ Lessells</name></author><author><name sortKey="Mutevedzi, Pc" uniqKey="Mutevedzi P">PC Mutevedzi</name></author><author><name sortKey="Cooke, Gs" uniqKey="Cooke G">GS Cooke</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mutevedzi, Pc" uniqKey="Mutevedzi P">PC Mutevedzi</name></author><author><name sortKey="Lessells, Rj" uniqKey="Lessells R">RJ Lessells</name></author><author><name sortKey="Heller, T" uniqKey="Heller T">T Heller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Malaza, A" uniqKey="Malaza A">A Malaza</name></author><author><name sortKey="Mossong, J" uniqKey="Mossong J">J Mossong</name></author><author><name sortKey="Barnighausen, T" uniqKey="Barnighausen T">T Barnighausen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cornell, M" uniqKey="Cornell M">M Cornell</name></author><author><name sortKey="Schomaker, M" uniqKey="Schomaker M">M Schomaker</name></author><author><name sortKey="Garone, Db" uniqKey="Garone D">DB Garone</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cornell, M" uniqKey="Cornell M">M Cornell</name></author><author><name sortKey="Mcintyre, J" uniqKey="Mcintyre J">J McIntyre</name></author><author><name sortKey="Myer, L" uniqKey="Myer L">L Myer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shand, T" uniqKey="Shand T">T Shand</name></author><author><name sortKey="Thomson De Boor, H" uniqKey="Thomson De Boor H">H Thomson-de Boor</name></author><author><name sortKey="Van Den Berg, W" uniqKey="Van Den Berg W">W van den Berg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wallrauch, C" uniqKey="Wallrauch C">C Wallrauch</name></author><author><name sortKey="Heller, T" uniqKey="Heller T">T Heller</name></author><author><name sortKey="Lessells, R" uniqKey="Lessells R">R Lessells</name></author><author><name sortKey="Kekana, M" uniqKey="Kekana M">M Kekana</name></author><author><name sortKey="B Rnighausen, T" uniqKey="B Rnighausen T">T Bärnighausen</name></author><author><name sortKey="Newell, Ml" uniqKey="Newell M">ML Newell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hussain, A" uniqKey="Hussain A">A Hussain</name></author><author><name sortKey="Moodley, D" uniqKey="Moodley D">D Moodley</name></author><author><name sortKey="Naidoo, S" uniqKey="Naidoo S">S Naidoo</name></author><author><name sortKey="Esterhuizen, Tm" uniqKey="Esterhuizen T">TM Esterhuizen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Er Sande, Ma" uniqKey="Van Er Sande M">MA van der Sande</name></author><author><name sortKey="Schim Van Der Loeff, Mf" uniqKey="Schim Van Der Loeff M">MF Schim van der Loeff</name></author><author><name sortKey="Aveika, Aa" uniqKey="Aveika A">AA Aveika</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chandrasekhar, A" uniqKey="Chandrasekhar A">A Chandrasekhar</name></author><author><name sortKey="Gupta, A" uniqKey="Gupta A">A Gupta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grobler, L" uniqKey="Grobler L">L Grobler</name></author><author><name sortKey="Siegfried, N" uniqKey="Siegfried N">N Siegfried</name></author><author><name sortKey="Visser, Me" uniqKey="Visser M">ME Visser</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Irlam, Jh" uniqKey="Irlam J">JH Irlam</name></author><author><name sortKey="Visser, Mm" uniqKey="Visser M">MM Visser</name></author><author><name sortKey="Rollins, Nn" uniqKey="Rollins N">NN Rollins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weiser, Sd" uniqKey="Weiser S">SD Weiser</name></author><author><name sortKey="Young, Sl" uniqKey="Young S">SL Young</name></author><author><name sortKey="Cohen, Cr" uniqKey="Cohen C">CR Cohen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mlisana, K" uniqKey="Mlisana K">K Mlisana</name></author><author><name sortKey="Werner, L" uniqKey="Werner L">L Werner</name></author><author><name sortKey="Garrett, Nj" uniqKey="Garrett N">NJ Garrett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Babiker, Ag" uniqKey="Babiker A">AG Babiker</name></author><author><name sortKey="Emery, S" uniqKey="Emery S">S Emery</name></author><author><name sortKey="Fatkenheuer, G" uniqKey="Fatkenheuer G">G Fatkenheuer</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Anglaret, X" uniqKey="Anglaret X">X Anglaret</name></author><author><name sortKey="Scott, Ca" uniqKey="Scott C">CA Scott</name></author><author><name sortKey="Walensky, Rp" uniqKey="Walensky R">RP Walensky</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fox, Mp" uniqKey="Fox M">MP Fox</name></author><author><name sortKey="Cutsem, Gv" uniqKey="Cutsem G">GV Cutsem</name></author><author><name sortKey="Giddy, J" uniqKey="Giddy J">J Giddy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mutevedzi, Pc" uniqKey="Mutevedzi P">PC Mutevedzi</name></author><author><name sortKey="Lessells, Rj" uniqKey="Lessells R">RJ Lessells</name></author><author><name sortKey="Newell, Ml" uniqKey="Newell M">ML Newell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nglazi, Md" uniqKey="Nglazi M">MD Nglazi</name></author><author><name sortKey="Lawn, Sd" uniqKey="Lawn S">SD Lawn</name></author><author><name sortKey="Kaplan, R" uniqKey="Kaplan R">R Kaplan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Holmes, Cb" uniqKey="Holmes C">CB Holmes</name></author><author><name sortKey="Wood, R" uniqKey="Wood R">R Wood</name></author><author><name sortKey="Badri, M" uniqKey="Badri M">M Badri</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Iwuji, Cc" uniqKey="Iwuji C">CC Iwuji</name></author><author><name sortKey="Orne Gliemann, J" uniqKey="Orne Gliemann J">J Orne-Gliemann</name></author><author><name sortKey="Tanser, F" uniqKey="Tanser F">F Tanser</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vermund, Sh" uniqKey="Vermund S">SH Vermund</name></author><author><name sortKey="Fidler, Sj" uniqKey="Fidler S">SJ Fidler</name></author><author><name sortKey="Ayles, H" uniqKey="Ayles H">H Ayles</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Plazy, M" uniqKey="Plazy M">M Plazy</name></author><author><name sortKey="Dray Spira, R" uniqKey="Dray Spira R">R Dray-Spira</name></author><author><name sortKey="Orne Gliemann, J" uniqKey="Orne Gliemann J">J Orne-Gliemann</name></author><author><name sortKey="Dabis, F" uniqKey="Dabis F">F Dabis</name></author><author><name sortKey="Newell, Ml" uniqKey="Newell M">ML Newell</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">HIV Med</journal-id><journal-id journal-id-type="iso-abbrev">HIV Med</journal-id><journal-id journal-id-type="publisher-id">hiv</journal-id><journal-title-group><journal-title>HIV Medicine</journal-title></journal-title-group><issn pub-type="ppub">1464-2662</issn><issn pub-type="epub">1468-1293</issn><publisher><publisher-name>John Wiley & Sons, Ltd</publisher-name><publisher-loc>Chichester, UK</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25959724</article-id><article-id pub-id-type="pmc">4682449</article-id><article-id pub-id-type="doi">10.1111/hiv.12255</article-id><article-categories><subj-group subj-group-type="heading"><subject>Short Communication</subject></subj-group></article-categories><title-group><article-title>Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>McGrath</surname><given-names>N</given-names></name><xref ref-type="aff" rid="au1">1</xref><xref ref-type="aff" rid="au2">2</xref><xref ref-type="aff" rid="au3">3</xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Lessells</surname><given-names>RJ</given-names></name><xref ref-type="aff" rid="au3">3</xref><xref ref-type="aff" rid="au4">4</xref></contrib><contrib contrib-type="author"><name><surname>Newell</surname><given-names>ML</given-names></name><xref ref-type="aff" rid="au2">2</xref><xref ref-type="aff" rid="au3">3</xref><xref ref-type="aff" rid="au5">5</xref></contrib><aff id="au1"><label>1</label><institution>Academic Unit of Primary Care and Population Sciences, University of Southampton</institution><addr-line>Southampton, UK</addr-line></aff><aff id="au2"><label>2</label><institution>Department of Social Statistics and Demography, University of Southampton</institution><addr-line>Southampton, UK</addr-line></aff><aff id="au3"><label>3</label><institution>Africa Centre for Health and Population Studies, University of KwaZulu-Natal</institution><addr-line>Mtubatuba, South Africa</addr-line></aff><aff id="au4"><label>4</label><institution>Department of Clinical Research, London School of Hygiene and Tropical Medicine</institution><addr-line>London, UK</addr-line></aff><aff id="au5"><label>5</label><institution>Academic Unit of Human Development and Health, University of Southampton</institution><addr-line>Southampton, UK</addr-line></aff></contrib-group><author-notes><corresp id="cor1">Correspondence: Dr Nuala McGrath, Faculty of Medicine, University of Southampton, Southampton General Hospital, Mailpoint 805, South Academic Block, Level C Room AC23, Tremona Road, Southampton SO16 6YD, UK. Tel: +44 23 8120 5749; fax: +44 23 81206529 2; e-mail: <email>n.mcgrath@soton.ac.uk</email></corresp></author-notes><pub-date pub-type="ppub"><month>9</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>11</day><month>5</month><year>2015</year></pub-date><volume>16</volume><issue>8</issue><fpage>512</fpage><lpage>518</lpage><history><date date-type="accepted"><day>16</day><month>1</month><year>2015</year></date></history><permissions><copyright-statement>© 2015 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>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.</license-p></license></permissions><abstract><sec><title>Objectives</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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].</p></sec><sec><title>Conclusions</title><p>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.</p></sec></abstract><kwd-group><kwd>antiretroviral therapy</kwd><kwd>HIV</kwd><kwd>sub-Saharan Africa</kwd></kwd-group></article-meta></front><body><sec><title>Introduction</title><p>By the end of 2012, in sub-Saharan Africa, an estimated seven million people of 25 million living with HIV received antiretroviral therapy (ART) <xref rid="b1" ref-type="bibr">[1]</xref>, but most HIV-infected people have either not yet accessed or are not yet eligible for ART. With increasing numbers of people diagnosed early in the course of infection, there is a need for evidence-based care strategies for this group <xref rid="b1" ref-type="bibr">[1]</xref>.</p><p>Studies in different settings have estimated the time from HIV-1 seroconversion to reaching a CD4 cell count threshold of 350 cells/μl for treatment eligibility to be 4–5 years <xref rid="b2" ref-type="bibr">[2]</xref>,<xref rid="b3" ref-type="bibr">[3]</xref>. Virological and immunological factors associated with disease progression have been well characterized <xref rid="b4" ref-type="bibr">[4]</xref>, but the impact of sociodemographic and psycho-behavioural factors on disease progression and time to ART eligibility has been studied less extensively, particularly in sub-Saharan Africa <xref rid="b5" ref-type="bibr">[5]</xref>,<xref rid="b6" ref-type="bibr">[6]</xref>. Understanding the influence of these factors on HIV disease progression is important to inform pre-ART care and monitoring strategies, and for policy decisions concerning the timing of ART initiation and the use of ART for prevention. There are few data on time to ART eligibility in those who present in early HIV infection, although increasing numbers of people are diagnosed and enter care at higher CD4 cell counts <xref rid="b7" ref-type="bibr">[7]</xref>. We used data from a longitudinal study investigating the impact of ART on the partnerships and sexual behaviour of HIV-infected individuals to explore factors associated with disease progression in adults in the early stages of HIV infection <xref rid="b8" ref-type="bibr">[8]</xref>.</p></sec><sec sec-type="methods"><title>Methods</title><p>People can access HIV counselling and testing at any primary health care (PHC) clinic in the Hlabisa sub-district <xref rid="b9" ref-type="bibr">[9]</xref>. Blood is taken for CD4 cell count measurement immediately after a positive HIV diagnosis. The South African guidelines for ART eligibility have changed over the course of this study: CD4 cell count < 200 cells/μl or World Health Organization (WHO) stage 4 until March 2010; CD4 cell count cut-off < 350 cells/μl for pregnant women and individuals with active tuberculosis (TB) disease from April 2010 to August 2011; < 350 cells/μl for all from August 2011.</p><p>Adult (≥ 18 years old) HIV-infected men and nonpregnant women accessing care at three of the PHC clinics and resident within the Africa Centre Demographic Surveillance Area were potentially eligible for inclusion in the parent study and were approached for recruitment if their CD4 cell count was < 200 cells/μl or > 500 cells/μl <xref rid="b8" ref-type="bibr">[8]</xref>. Individuals were asked to consent separately to linkage of their study data with routine clinical data collected in the HIV programme, specifically clinic attendance history and laboratory test results, and with the Africa Centre Demographic Information System (ACDIS) database for their residential history. Sociodemographic, behavioural and partnership-level data were collected at enrolment <xref rid="b10" ref-type="bibr">[10]</xref>. Study participants were interviewed 6-monthly during routine clinic visits, or where necessary during home visits or by phone.</p><p>The study was approved by the ethics committees of the University of KwaZulu-Natal (BF083/08), the London School of Hygiene and Tropical Medicine (5413), and the KwaZulu-Natal Department of Health.</p><p>Individuals with CD4 cell count > 500 cells/μl at enrolment were advised to return 6-monthly for repeat clinical assessment and CD4 cell count measurement; those with at least one post-enrolment CD4 cell count result contributed to the analyses. Characteristics at enrolment for individuals included in the analyses were compared with those for individuals who were not using χ<sup>2</sup> tests for categorical variables and Wilcoxon rank sum tests for continuous variables.</p><p>Study recruitment started in January 2009, with follow-up for 36 months maximum. While many individuals continued to access care from the local HIV programme, with additional post-study CD4 cell count results, only results from tests conducted during study follow-up were included in this analysis.</p><p>Individuals who initiated ART for clinical reasons were also considered ART-eligible; their ART initiation date was their eligibility date. ART initiation date was documented during follow-up or by linkage to the HIV programme database. Follow-up time for individuals not meeting ART eligibility criteria was censored at the last CD4 cell count test date.</p><p>Time from study enrolment to ART eligibility, defined as CD4 cell count < 350 cells/μl, was estimated by Kaplan − Meier survival analysis. Associations between the time to ART eligibility and sociodemographic and behavioural factors at enrolment, including ART knowledge, social capital, social support, relationship characteristics, and internalized HIV stigma (composite score from adapted scales), were initially explored using univariable Cox models [8,10]. We considered all variables that were significant at univariable level (p value < 0.05) for the multivariable model. Given previously reported faster disease progression in men, we explored an interaction term between CD4 cell count and sex in the final multivariable model. CD4 cell count was included in the model as a set of binary indicators representing quartiles of the baseline distribution: ≤ 559, 560–632, 633–768 and > 768 cells/μl. The interaction between CD4 cell count and sex was tested using seven binary indicators to represent the eight possible categories. A likelihood ratio test of this interaction was performed and the results compared to a χ<sup>2</sup> distribution with three degrees of freedom. The final model was tested to check that the proportional hazards assumption held.</p></sec><sec sec-type="results"><title>Results</title><p>Overall, 247 adults had been enrolled by March 2011; 41 (17%) had no post-enrolment CD4 cell count result and did not contribute to the analyses. These 41 did not differ from the 206 included by age (<italic>P</italic> = 0.46), sex (<italic>P</italic> = 0.56) and enrolment CD4 cell count (<italic>P</italic> = 0.69). Thus, 206 adults (14% male; median age 34 years) contributed 381 years of follow-up [median 24 months; interquartile range (IQR) 15–30 months] (Table <xref ref-type="table" rid="tbl1">1</xref>), with a median number of CD4 cell count measurements of 3 (IQR 2–4). CD4 cell count measurement number was not significantly associated with any factor included in the final model (data not shown). Overall, 79 (38%) participants became eligible for ART: 75 by CD4 cell count criteria (< 350 cells/μl) and four for clinical reasons. Among these 79, 41 (52%) started ART during study follow-up. Based on a CD4 cell count of 500 cells/μl, 129 (63%) would have become eligible for ART.</p><table-wrap id="tbl1" position="float"><label>Table 1</label><caption><p>Selected characteristics of study participants at enrolment (<italic>n</italic> = 206)</p></caption><table frame="hsides" rules="groups"><tbody><tr><td align="left" rowspan="1" colspan="1"><italic>Demographic</italic></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Sex, female [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">178 (86)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Age (years) [median (IQR)]</td><td align="left" rowspan="1" colspan="1">34 (28, 43)</td></tr><tr><td align="left" rowspan="1" colspan="1">Enrolment CD4 count [<italic>n</italic> (%)]</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> ≤ 559 cells/μL</td><td align="left" rowspan="1" colspan="1">53 (26)</td></tr><tr><td align="left" rowspan="1" colspan="1"> 560–632 cells/μL</td><td align="left" rowspan="1" colspan="1">51 (24)</td></tr><tr><td align="left" rowspan="1" colspan="1"> 633–768 cells/μL</td><td align="left" rowspan="1" colspan="1">53 (26)</td></tr><tr><td align="left" rowspan="1" colspan="1"> > 768 cells/μL</td><td align="left" rowspan="1" colspan="1">49 (24)</td></tr><tr><td align="left" rowspan="1" colspan="1">Current marital status [<italic>n</italic> (%)]</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Never married</td><td align="left" rowspan="1" colspan="1">163 (79)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Monogamous marriage</td><td align="left" rowspan="1" colspan="1">27 (13)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Polygamous marriage</td><td align="left" rowspan="1" colspan="1">3 (1)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Separated/divorced/widowed</td><td align="left" rowspan="1" colspan="1">13 (6)</td></tr><tr><td align="left" rowspan="1" colspan="1">Religion [<italic>n</italic> (%)]</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> None</td><td align="left" rowspan="1" colspan="1">15 (7)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Shembe</td><td align="left" rowspan="1" colspan="1">39 (19)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Zionist</td><td align="left" rowspan="1" colspan="1">62 (30)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Western Christian</td><td align="left" rowspan="1" colspan="1">78 (38)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Other</td><td align="left" rowspan="1" colspan="1">12 (6)</td></tr><tr><td align="left" rowspan="1" colspan="1">Education, achieved matriculation or higher [<italic>n</italic> (%)]<xref ref-type="table-fn" rid="tf1-1">a</xref></td><td align="left" rowspan="1" colspan="1">54 (27)</td></tr><tr><td align="left" rowspan="1" colspan="1">Parity [median (IQR)]<xref ref-type="table-fn" rid="tf1-2">b</xref></td><td align="left" rowspan="1" colspan="1">2 (2, 4)</td></tr><tr><td align="left" rowspan="1" colspan="1">Number of lifetime partners [<italic>n</italic> (%)]</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> 1</td><td align="left" rowspan="1" colspan="1">28 (14)</td></tr><tr><td align="left" rowspan="1" colspan="1"> 2–4</td><td align="left" rowspan="1" colspan="1">128 (62)</td></tr><tr><td align="left" rowspan="1" colspan="1"> ≥5</td><td align="left" rowspan="1" colspan="1">50 (24)</td></tr><tr><td align="left" rowspan="1" colspan="1">Number of children [median (IQR)]<xref ref-type="table-fn" rid="tf1-3">c</xref></td><td align="left" rowspan="1" colspan="1">3 (1, 4)</td></tr><tr><td align="left" rowspan="1" colspan="1">Employment [<italic>n</italic> (%)]</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Currently employed</td><td align="left" rowspan="1" colspan="1">42 (20)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Ever employed</td><td align="left" rowspan="1" colspan="1">108 (52)</td></tr><tr><td align="left" rowspan="1" colspan="1">Receiving social welfare grant [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">150 (73)</td></tr><tr><td align="left" rowspan="1" colspan="1">Household unable to afford food in past 12 months [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">44 (21)</td></tr><tr><td align="left" rowspan="1" colspan="1">Always resident in Africa Centre DSA [<italic>n</italic> (%)]<xref ref-type="table-fn" rid="tf1-4">d</xref></td><td align="left" rowspan="1" colspan="1">86 (42)</td></tr><tr><td align="left" rowspan="1" colspan="1">Stigma score [median (IQR)]<xref ref-type="table-fn" rid="tf1-5">e</xref></td><td align="left" rowspan="1" colspan="1">42 (36,48)</td></tr><tr><td align="left" rowspan="1" colspan="1">Gender norms score [median (IQR)]<xref ref-type="table-fn" rid="tf1-6">f</xref></td><td align="left" rowspan="1" colspan="1">39 (37, 43)</td></tr><tr><td align="left" rowspan="1" colspan="1">Taken nutritional supplements in first 6 months of study [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">23 (11)</td></tr><tr><td align="left" rowspan="1" colspan="1"><italic>Social capital</italic></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Neighbour would contribute time for a project [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">149 (72)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Neighbour would contribute money (R10) for a project [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">138 (67)</td></tr><tr><td align="left" rowspan="1" colspan="1">Who would deal with a problem that affected the entire neighbourhood? [<italic>n</italic> (%)]</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Municipal/district leaders</td><td align="left" rowspan="1" colspan="1">46 (22)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Each person/household individually or neighbours</td><td align="left" rowspan="1" colspan="1">14 (7)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Traditional leaders</td><td align="left" rowspan="1" colspan="1">74 (36)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Traditional and municipal/district leaders would act together</td><td align="left" rowspan="1" colspan="1">72 (35)</td></tr><tr><td align="left" rowspan="1" colspan="1">Community groups in neighbourhood, yes [<italic>n</italic> (%)]</td><td align="left" rowspan="1" colspan="1">156 (76)</td></tr><tr><td align="left" rowspan="1" colspan="1">How much can you rely on family/friends if you have a serious problem? [<italic>n</italic> (%)]</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> A little</td><td align="left" rowspan="1" colspan="1">22 (11)</td></tr><tr><td align="left" rowspan="1" colspan="1"> A lot</td><td align="left" rowspan="1" colspan="1">179 (87)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Not at all</td><td align="left" rowspan="1" colspan="1">5 (2)</td></tr><tr><td align="left" rowspan="1" colspan="1">How often do you spend time with neighbours? [<italic>n</italic> (%)]</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Every day</td><td align="left" rowspan="1" colspan="1">65 (32)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Several days a week</td><td align="left" rowspan="1" colspan="1">53 (26)</td></tr><tr><td align="left" rowspan="1" colspan="1"> At least once a fortnight</td><td align="left" rowspan="1" colspan="1">8 (4)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Once a month</td><td align="left" rowspan="1" colspan="1">24 (12)</td></tr><tr><td align="left" rowspan="1" colspan="1"> Less than once a month/not at all</td><td align="left" rowspan="1" colspan="1">56 (27)</td></tr></tbody></table><table-wrap-foot><fn id="tf1-1"><label>a</label><p>Data missing for eight patients.</p></fn><fn id="tf1-2"><label>b</label><p>Female patients only; data missing for five patients.</p></fn><fn id="tf1-3"><label>c</label><p>Male patients only.</p></fn><fn id="tf1-4"><label>d</label><p>Data available for <italic>n</italic> = 170. In the Africa Centre surveillance system, household membership is not conditional on residency; an individual can be recorded as a nonresident household member if they are residing in a household outside the demographic surveillance area (DSA) but remain socially connected to a household in the DSA. Changes in residence by individuals and households within the DSA (internal migration) and into or out of the DSA (external migration) have been documented since January 2000.</p></fn><fn id="tf1-5"><label>e</label><p>HIV stigma was measured by a set of 24 questions adapted from Sayles <italic>et al</italic>.’s 28-item scale <xref rid="b11" ref-type="bibr">[11]</xref>. The questions assessed the individual’s perceived HIV stigma in the community and internalized HIV stigma. Higher stigma score represents greater HIV-related stigma. The maximum possible stigma score was 72 and the minimum was 24.</p></fn><fn id="tf1-6"><label>f</label><p>Gender norms were measured by a set of 19 questions from 24 questions developed by Pulerwitz <italic>et al</italic>. <xref rid="b12" ref-type="bibr">[12]</xref>. Although the Pulerwitz <italic>et al</italic>. gender norms scale was originally administered to men only, on review it was considered an appropriate measure of gender norms for both sexes and administered to men and women. Scores could range between 19 and 57, with higher scores indicating more equitable gender norms and lower scores indicating male-dominant gender norms.</p></fn><fn><p>DSA, demographic surveillance area; IQR, interquartile range.</p></fn></table-wrap-foot></table-wrap><p>Univariably, the following were significantly associated with increased hazard of becoming ART-eligible: male sex [hazard ratio (HR) 3.13; 95% confidence interval (CI) 1.82–5.39; <italic>P</italic> < 0.001], older age [reference ≤ 30 years; 31–40 years, HR 2.16 (95% CI 1.24–3.75); ≥ 41 years, HR 1.55 (95% CI 0.88–2.76); <italic>P</italic> = 0.02], self-report of household going without food in the previous 12 months (HR 1.58; 95% CI 0.99–2.54; <italic>P</italic> = 0.057), higher number of lifetime partners [reference 1 partner; 2–4 partners, HR 1.33 (95% CI 0.63–2.83); ≥ 5 partners, HR 2.40 (95% CI 1.08–5.33); <italic>P</italic> = 0.032], lower enrolment CD4 cell count [reference ≤ 559 cells/μl; 560–632 cells/μl, HR 0.73 (95% CI 0.42–1.26); 633–768 cells/μl, HR 0.41 (95% CI 0.22–0.75); > 768 cells/μl, HR 0.20 (95% CI 0.09–0.45); <italic>P</italic> < 0.001], taking nutritional supplements between enrolment and 6 months (HR 2.06; 95% CI 1.11–3.83; <italic>P</italic> = 0.022) and ever use of recreational drugs (HR 2.35; 95% CI 1.08–5.15; <italic>P</italic> = 0.03) (Table <xref ref-type="table" rid="tbl2">2</xref>). Once adjusted for sex, the number of lifetime partners and ever use of recreational drugs were no longer significant. Reported ever alcohol use was 35% among female patients and 89% among male patients (<italic>P</italic> < 0.001), and reported use in the first 6 months of follow-up was 4% and 43% among female and male patients, respectively. Neither ever or current alcohol use was associated with time to ART eligibility. The limited number of female current drinkers hindered exploration of associations between time to ART eligibility and alcohol use in a model including male sex.</p><table-wrap id="tbl2" position="float"><label>Table 2</label><caption><p>Multivariable Cox proportional hazards regression analysis of factors associated with time to antiretroviral therapy (ART) eligibility</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Variable</th><th align="left" rowspan="1" colspan="1">HR</th><th align="left" rowspan="1" colspan="1">95% CI</th><th align="left" rowspan="1" colspan="1">aHR</th><th align="left" rowspan="1" colspan="1">95% CI</th><th align="left" rowspan="1" colspan="1"><italic>P</italic> value</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Enrolment CD4 cell count</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> ≤559 cells/μL</td><td align="left" rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> 560–632 cells/μL</td><td align="left" rowspan="1" colspan="1">0.73</td><td align="left" rowspan="1" colspan="1">0.42–1.28</td><td align="left" rowspan="1" colspan="1">0.46</td><td align="left" rowspan="1" colspan="1">0.25–0.83</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> 633–768 cells/μL</td><td align="left" rowspan="1" colspan="1">0.41</td><td align="left" rowspan="1" colspan="1">0.22–0.75</td><td align="left" rowspan="1" colspan="1">0.30</td><td align="left" rowspan="1" colspan="1">0.16–0.57</td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> >768 cells/μL</td><td align="left" rowspan="1" colspan="1">0.20</td><td align="left" rowspan="1" colspan="1">0.09–0.45</td><td align="left" rowspan="1" colspan="1">0.17</td><td align="left" rowspan="1" colspan="1">0.08–0.38</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Sex</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Female</td><td align="left" rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Male</td><td align="left" rowspan="1" colspan="1">3.13</td><td align="left" rowspan="1" colspan="1">1.82–5.39</td><td align="left" rowspan="1" colspan="1">4.00</td><td align="left" rowspan="1" colspan="1">2.20–7.28</td><td align="left" rowspan="1" colspan="1"><0.001</td></tr><tr><td align="left" rowspan="1" colspan="1">Household unable to afford food in past 12 months</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="left" rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="left" rowspan="1" colspan="1">1.58</td><td align="left" rowspan="1" colspan="1">0.99–2.54</td><td align="left" rowspan="1" colspan="1">1.58</td><td align="left" rowspan="1" colspan="1">0.98–2.54</td><td align="left" rowspan="1" colspan="1">0.062</td></tr><tr><td align="left" rowspan="1" colspan="1">Taken nutritional supplements in first 6 months of study</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> No</td><td align="left" rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1"></td><td rowspan="1" colspan="1"></td></tr><tr><td align="left" rowspan="1" colspan="1"> Yes</td><td align="left" rowspan="1" colspan="1">2.06</td><td align="left" rowspan="1" colspan="1">1.11–3.83</td><td align="left" rowspan="1" colspan="1">2.38</td><td align="left" rowspan="1" colspan="1">1.26–4.48</td><td align="left" rowspan="1" colspan="1">0.007</td></tr></tbody></table><table-wrap-foot><fn id="tf2-1"><p>HR, hazard ratio; aHR, adjusted hazard ratio; CI, confidence interval.</p></fn></table-wrap-foot></table-wrap><p>Multivariably, lower CD4 cell count at enrolment, being male, residing in a household with food shortage in the last year, and nutritional supplement use remained significantly associated with increased hazard of meeting ART eligibility criteria (Table <xref ref-type="table" rid="tbl2">2</xref>). There was no evidence of an interaction between enrolment CD4 cell count and sex (<italic>P</italic> = 0.64). The proportional hazards assumption for the final model was met (global test <italic>P</italic> value = 0.81). Median time to ART eligibility at a CD4 cell count < 350 cells/μl was 12.0 months (95% CI 8.3–25.1 months) for men, and 33.9 months (95% CI 27.0–36.8 months) for women. The overall rate of progression to eligibility at a CD4 cell count < 350 cells/μl was 25.6 per 100 person-years (PY) (95% CI 20.5–31.9 per 100 PY); rates by year of follow-up were: 19.3 (95% CI 13.8–26.8) per 100 PY for the first year, 33.6 (95% CI 23.9–47.3) per 100 PY for the second year and 31.8 (95% CI 16.5–61.1) per 100 PY for the third year. Median time to CD4 cell count < 500 cells/μl for men was 8.3 months (95% CI 6.0–18.6 months) and for women it was 17.8 months (95% CI 15.9–19.7 months).</p></sec><sec sec-type="discussion"><title>Discussion</title><p>Just over one in three HIV-infected adults enrolled in HIV care at an early stage became eligible for ART at a CD4 cell count < 350 cells/μl. In these HIV-infected people with an initial CD4 count > 500 cells/μl, progression to ART eligibility was associated with lower baseline CD4 cell count, male sex, household food insecurity and the personal use of nutritional supplements.</p><p>The study population was predominantly female, consistent with previously reported data <xref rid="b9" ref-type="bibr">[9]</xref>,<xref rid="b13" ref-type="bibr">[13]</xref>,<xref rid="b14" ref-type="bibr">[14]</xref>, and probably reflecting higher population-level CD4 cell counts among women <xref rid="b15" ref-type="bibr">[15]</xref> and the different entry points into HIV care. Previous work did not find any association between sex and disease progression pre-ART initiation <xref rid="b4" ref-type="bibr">[4]</xref>; however, mortality after ART initiation is consistently higher in men <xref rid="b16" ref-type="bibr">[16]</xref>. Men enrolled in our study may be incompletely representative of all men with CD4 cell counts > 500 cells/μl as a consequence of unmeasured clinical characteristics, but our finding that time to ART eligibility was significantly shorter for men highlights the need to develop male-oriented strategies throughout HIV care <xref rid="b17" ref-type="bibr">[17]</xref>,<xref rid="b18" ref-type="bibr">[18]</xref>. Current guidelines recommend ART for all pregnant females and individuals with TB disease, regardless of CD4 cell count, but this was not the case throughout the study period. We did not estimate the effect this might have on overall progression to eligibility, although the estimates would be unlikely to change substantially as the majority of TB cases and pregnancies are associated with CD4 cell counts < 350 cells/μl in South Africa <xref rid="b19" ref-type="bibr">[19]</xref>,<xref rid="b20" ref-type="bibr">[20]</xref>.</p><p>Use of nutritional supplements in the first 6 months of follow-up may indicate poorer nutritional state and low body mass index (BMI); similarly, the association with self-reported household lack of food could also reflect a link between food insecurity, malnutrition and disease progression. Other household socioeconomic status indicators were not associated with time to ART eligibility, suggesting a specific role of nutrition <xref rid="b21" ref-type="bibr">[21]</xref>. However, there is no clear evidence that macronutrient or micronutrient supplementation delays HIV disease progression in nonpregnant adults 22–24. The complex interplay between HIV and nutrition means that determining cause and effect relationships is difficult; this was certainly the case in this analysis, given the study design and the lack of clinical indicators such as BMI <xref rid="b25" ref-type="bibr">[25]</xref>. There was no evidence of an association between disease progression and any behavioural factors (including ART knowledge, social capital, social support, relationship characteristics, and internalized stigma). Therefore, while interventions to address these issues may have merit, they should not be expected to delay disease progression.</p><p>Our results are similar to those from a smaller study, also from KwaZulu-Natal, of female patients monitored from HIV seroconversion, where 43% reached a CD4 cell count of < 350 cells/μl within 2 years <xref rid="b26" ref-type="bibr">[26]</xref>. Although the individual-level benefit/risk ratio of commencing ART at CD4 cell counts > 350 cells/μl has not yet been established <xref rid="b27" ref-type="bibr">[27]</xref>,<xref rid="b28" ref-type="bibr">[28]</xref>, international and national guidelines now recommend initiation of ART if the CD4 cell count is < 500 cells/μl <xref rid="b29" ref-type="bibr">[29]</xref>,<xref rid="b30" ref-type="bibr">[30]</xref>. Whereas immediate ART may improve survival in adults with CD4 cell counts > 500 cells/μl, this benefit might be reversed by potentially high rates of treatment failure or disengagement from care <xref rid="b31" ref-type="bibr">[31]</xref>; the latter may be more likely as programmes expand 32–34. In this population, around one in four adults now present for HIV care with a CD4 cell count > 500 cells/μl <xref rid="b7" ref-type="bibr">[7]</xref>; our finding that most of such adults had not become eligible during follow-up is consistent with regional natural history data <xref rid="b35" ref-type="bibr">[35]</xref> and suggests that risks of treatment failure and costs of treatment could be deferred for a considerable time. However, whether or not this changes the overall individual benefit/risk ratio and whether there are additional population-level risks or benefits remain to be seen <xref rid="b36" ref-type="bibr">[36]</xref>,<xref rid="b37" ref-type="bibr">[37]</xref>. Our data would suggest that many individuals will become eligible within one or two visits in pre-ART care, especially if visits are less frequent than the recommended 6 months <xref rid="b13" ref-type="bibr">[13]</xref>. Education and counselling should emphasize the importance of retention in care to all patients not yet requiring ART. Focused messages and systems may be required to enable retention of men, who may have faster disease progression and poorer retention in pre-ART care <xref rid="b13" ref-type="bibr">[13]</xref>,<xref rid="b38" ref-type="bibr">[38]</xref>.</p></sec></body><back><ack><p>We thank the individuals who participated in the study, Nompilo Myeni, Thabile Hlabisa, Nompilo Buthelezi, T.T. Khumalo, Khetiwhe Ngobese, Witness Ndlovu and Patrick Gabela (the study team), Department of Health clinic staff and Colin Newell, all of whom made this work possible.</p></ack><sec><title>Sources of funding</title><p>NM and RL were supported by Wellcome Trust fellowships (grant numbers WT083495MA and 090999/Z/09/Z, respectively). The Africa Centre receives core funding from the Wellcome Trust, including for the surveillance (grant 082384/Z/07/Z). The HIV Treatment and Care Programme received generous support between 2005 and 2013 from the United States Agency for International Development (USAID) and the President’s Emergency Plan for AIDS Relief (PEPFAR) under the terms of award no. 674-A-00-08-0001-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID or the United States Government.</p></sec><sec><title>Conflicts of interest</title><p>The authors declare that they have no conflicts of interest.</p></sec><ref-list><title>References</title><ref id="b1"><element-citation publication-type="book"><collab>Joint United Nations Programme on HIV/AIDS (UNAIDS)</collab><source>Global Report: UNAIDS Report on the Global AIDS Epidemic</source><year>2013</year><publisher-loc>Geneva, Switzerland</publisher-loc><publisher-name>UNAIDS</publisher-name><comment>Available at <ext-link ext-link-type="uri" xlink:href="http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf">http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf</ext-link> (accessed 2 November 2014)</comment></element-citation></ref><ref id="b2"><element-citation publication-type="journal"><collab>Eligibility for ART in Lower Income Countries (eART-linc) Collaboration</collab><person-group person-group-type="author"><name><surname>Wandel</surname><given-names>S</given-names></name><name><surname>Egger</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Duration from seroconversion to eligibility for antiretroviral therapy and from ART eligibility to death in adult HIV-infected patients from low and middle-income countries: collaborative analysis of prospective studies</article-title><source>Sex Transm Infect</source><year>2008</year><volume>84</volume><issue>Suppl 1</issue><fpage>i31</fpage><lpage>i36</lpage><pub-id pub-id-type="pmid">18647863</pub-id></element-citation></ref><ref id="b3"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lodi</surname><given-names>S</given-names></name><name><surname>Phillips</surname><given-names>A</given-names></name><name><surname>Touloumi</surname><given-names>G</given-names></name><etal></etal></person-group><article-title>Time from human immunodeficiency virus seroconversion to reaching CD4 + cell count thresholds < 200, < 350, and < 500 Cells/mm(3): assessment of need following changes in treatment guidelines</article-title><source>Clin Infect Dis</source><year>2011</year><volume>53</volume><fpage>817</fpage><lpage>825</lpage><pub-id pub-id-type="pmid">21921225</pub-id></element-citation></ref><ref id="b4"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Langford</surname><given-names>SE</given-names></name><name><surname>Ananworanich</surname><given-names>J</given-names></name><name><surname>Cooper</surname><given-names>DA</given-names></name></person-group><article-title>Predictors of disease progression in HIV infection: a review</article-title><source>AIDS Res Ther</source><year>2007</year><volume>4</volume><fpage>11</fpage><pub-id pub-id-type="pmid">17502001</pub-id></element-citation></ref><ref id="b5"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chida</surname><given-names>Y</given-names></name><name><surname>Vedhara</surname><given-names>K</given-names></name></person-group><article-title>Adverse psychosocial factors predict poorer prognosis in HIV disease: a meta-analytic review of prospective investigations</article-title><source>Brain Behav Immun</source><year>2009</year><volume>23</volume><fpage>434</fpage><lpage>445</lpage><pub-id pub-id-type="pmid">19486650</pub-id></element-citation></ref><ref id="b6"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ironson</surname><given-names>G</given-names></name><name><surname>Hayward</surname><given-names>H</given-names></name></person-group><article-title>Do positive psychosocial factors predict disease progression in HIV-1? A review of the evidence</article-title><source>Psychosom Med</source><year>2008</year><volume>70</volume><fpage>546</fpage><lpage>554</lpage><pub-id pub-id-type="pmid">18541905</pub-id></element-citation></ref><ref id="b7"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lessells</surname><given-names>RJ</given-names></name><name><surname>Mutevedzi</surname><given-names>PC</given-names></name><name><surname>Iwuji</surname><given-names>CC</given-names></name><etal></etal></person-group><article-title>Reduction in early mortality on antiretroviral therapy for adults in rural South Africa since change in CD4 + cell count eligibility criteria</article-title><source>J Acquir Immune Defic Syndr</source><year>2014</year><volume>65</volume><fpage>e17</fpage><lpage>e24</lpage><pub-id pub-id-type="pmid">23756374</pub-id></element-citation></ref><ref id="b8"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McGrath</surname><given-names>N</given-names></name><name><surname>Richter</surname><given-names>L</given-names></name><name><surname>Newell</surname><given-names>ML</given-names></name></person-group><article-title>Design and methods of a longitudinal study investigating the impact of antiretroviral treatment on the partnerships and sexual behaviour of HIV-infected individuals in rural KwaZulu-Natal, South Africa</article-title><source>BMC Public Health</source><year>2011</year><volume>11</volume><fpage>121</fpage><pub-id pub-id-type="pmid">21333022</pub-id></element-citation></ref><ref id="b9"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Houlihan</surname><given-names>CF</given-names></name><name><surname>Bland</surname><given-names>RM</given-names></name><name><surname>Mutevedzi</surname><given-names>PC</given-names></name><etal></etal></person-group><article-title>Cohort profile: hlabisa HIV treatment and care programme</article-title><source>Int J Epidemiol</source><year>2011</year><volume>40</volume><fpage>318</fpage><lpage>326</lpage><pub-id pub-id-type="pmid">20154009</pub-id></element-citation></ref><ref id="b10"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McGrath</surname><given-names>N</given-names></name><name><surname>Richter</surname><given-names>L</given-names></name><name><surname>Newell</surname><given-names>ML</given-names></name></person-group><article-title>Sexual risk after HIV diagnosis: a comparison of pre-ART individuals with CD4 > 500 cells/microl and ART-eligible individuals in a HIV treatment and care programme in rural KwaZulu-Natal, South Africa</article-title><source>J Int AIDS Soc</source><year>2013</year><volume>16</volume><fpage>18048</fpage><pub-id pub-id-type="pmid">23920209</pub-id></element-citation></ref><ref id="b11"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sayles</surname><given-names>JN</given-names></name><name><surname>Hays</surname><given-names>RD</given-names></name><name><surname>Sarkisian</surname><given-names>CA</given-names></name><etal></etal></person-group><article-title>Development and psychometric assessment of a multidimensional measure of internalized HIV stigma in a sample of HIV-positive adults</article-title><source>AIDS Behav</source><year>2008</year><volume>12</volume><fpage>748</fpage><lpage>758</lpage><pub-id pub-id-type="pmid">18389363</pub-id></element-citation></ref><ref id="b12"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pulerwitz</surname><given-names>J</given-names></name><name><surname>Barker</surname><given-names>G</given-names></name></person-group><article-title>Measuring attitudes toward gender norms among young men in Brazil: development and psychometric evaluation of the GEM scale</article-title><source>Men Masculinities</source><year>2007</year><volume>10</volume><fpage>322</fpage><lpage>338</lpage></element-citation></ref><ref id="b13"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lessells</surname><given-names>RJ</given-names></name><name><surname>Mutevedzi</surname><given-names>PC</given-names></name><name><surname>Cooke</surname><given-names>GS</given-names></name><etal></etal></person-group><article-title>Retention in HIV care for individuals not yet eligible for antiretroviral therapy: rural KwaZulu-Natal, South Africa</article-title><source>J Acquir Immune Defic Syndr</source><year>2011</year><volume>56</volume><fpage>e79</fpage><lpage>e86</lpage><pub-id pub-id-type="pmid">21157360</pub-id></element-citation></ref><ref id="b14"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mutevedzi</surname><given-names>PC</given-names></name><name><surname>Lessells</surname><given-names>RJ</given-names></name><name><surname>Heller</surname><given-names>T</given-names></name><etal></etal></person-group><article-title>Scale-up of a decentralized HIV treatment programme in rural KwaZulu-Natal, South Africa: does rapid expansion affect patient outcomes?</article-title><source>Bull World Health Organ</source><year>2010</year><volume>88</volume><fpage>593</fpage><lpage>600</lpage><pub-id pub-id-type="pmid">20680124</pub-id></element-citation></ref><ref id="b15"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Malaza</surname><given-names>A</given-names></name><name><surname>Mossong</surname><given-names>J</given-names></name><name><surname>Barnighausen</surname><given-names>T</given-names></name><etal></etal></person-group><article-title>Population-based CD4 counts in a rural area in South Africa with high HIV prevalence and high antiretroviral treatment coverage</article-title><source>PLoS ONE</source><year>2013</year><volume>8</volume><fpage>e70126</fpage><pub-id pub-id-type="pmid">23894603</pub-id></element-citation></ref><ref id="b16"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cornell</surname><given-names>M</given-names></name><name><surname>Schomaker</surname><given-names>M</given-names></name><name><surname>Garone</surname><given-names>DB</given-names></name><etal></etal></person-group><article-title>Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study</article-title><source>PLoS Med</source><year>2012</year><volume>9</volume><fpage>e1001304</fpage><pub-id pub-id-type="pmid">22973181</pub-id></element-citation></ref><ref id="b17"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cornell</surname><given-names>M</given-names></name><name><surname>McIntyre</surname><given-names>J</given-names></name><name><surname>Myer</surname><given-names>L</given-names></name></person-group><article-title>Men and antiretroviral therapy in Africa: our blind spot</article-title><source>Trop Med Int Health</source><year>2011</year><volume>16</volume><fpage>828</fpage><lpage>829</lpage><pub-id pub-id-type="pmid">21418449</pub-id></element-citation></ref><ref id="b18"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Shand</surname><given-names>T</given-names></name><name><surname>Thomson-de Boor</surname><given-names>H</given-names></name><name><surname>van den Berg</surname><given-names>W</given-names></name><etal></etal></person-group><article-title>The HIV blind spot: men and HIV testing, treatment and care in Sub-Saharan Africa</article-title><source>IDS Bull</source><year>2014</year><volume>45</volume><fpage>53</fpage><lpage>60</lpage></element-citation></ref><ref id="b19"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wallrauch</surname><given-names>C</given-names></name><name><surname>Heller</surname><given-names>T</given-names></name><name><surname>Lessells</surname><given-names>R</given-names></name><name><surname>Kekana</surname><given-names>M</given-names></name><name><surname>Bärnighausen</surname><given-names>T</given-names></name><name><surname>Newell</surname><given-names>ML</given-names></name></person-group><article-title>High uptake of HIV testing for tuberculosis patients in an integrated primary health care HIV/TB programme in rural KwaZulu-Natal</article-title><source>S Afr Med J</source><year>2010</year><volume>100</volume><fpage>146</fpage><lpage>147</lpage><pub-id pub-id-type="pmid">20459930</pub-id></element-citation></ref><ref id="b20"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hussain</surname><given-names>A</given-names></name><name><surname>Moodley</surname><given-names>D</given-names></name><name><surname>Naidoo</surname><given-names>S</given-names></name><name><surname>Esterhuizen</surname><given-names>TM</given-names></name></person-group><article-title>Pregnant women’s access to PMTCT and ART services in South Africa and implications for universal antiretroviral treatment</article-title><source>PLoS ONE</source><year>2011</year><volume>6</volume><fpage>e27907</fpage><pub-id pub-id-type="pmid">22162993</pub-id></element-citation></ref><ref id="b21"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>van der Sande</surname><given-names>MA</given-names></name><name><surname>Schim van der Loeff</surname><given-names>MF</given-names></name><name><surname>Aveika</surname><given-names>AA</given-names></name><etal></etal></person-group><article-title>Body mass index at time of HIV diagnosis: a strong and independent predictor of survival</article-title><source>J Acquir Immune Defic Syndr</source><year>2004</year><volume>37</volume><fpage>1288</fpage><lpage>1294</lpage><pub-id pub-id-type="pmid">15385737</pub-id></element-citation></ref><ref id="b22"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chandrasekhar</surname><given-names>A</given-names></name><name><surname>Gupta</surname><given-names>A</given-names></name></person-group><article-title>Nutrition and disease progression pre-highly active antiretroviral therapy (HAART) and post-HAART: can good nutrition delay time to HAART and affect response to HAART?</article-title><source>Am J Clin Nutr</source><year>2011</year><volume>94</volume><fpage>1703S</fpage><lpage>1715S</lpage><pub-id pub-id-type="pmid">22089439</pub-id></element-citation></ref><ref id="b23"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Grobler</surname><given-names>L</given-names></name><name><surname>Siegfried</surname><given-names>N</given-names></name><name><surname>Visser</surname><given-names>ME</given-names></name><etal></etal></person-group><article-title>Nutritional interventions for reducing morbidity and mortality in people with HIV</article-title><source>Cochrane Database Syst Rev</source><year>2013</year><issue>2</issue><comment>CD004536</comment></element-citation></ref><ref id="b24"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Irlam</surname><given-names>JH</given-names></name><name><surname>Visser</surname><given-names>MM</given-names></name><name><surname>Rollins</surname><given-names>NN</given-names></name><etal></etal></person-group><article-title>Micronutrient supplementation in children and adults with HIV infection</article-title><source>Cochrane Database Syst Rev</source><year>2010</year><issue>12</issue><comment>CD003650</comment></element-citation></ref><ref id="b25"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Weiser</surname><given-names>SD</given-names></name><name><surname>Young</surname><given-names>SL</given-names></name><name><surname>Cohen</surname><given-names>CR</given-names></name><etal></etal></person-group><article-title>Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS</article-title><source>Am J Clin Nutr</source><year>2011</year><volume>94</volume><fpage>1729S</fpage><lpage>1739S</lpage><pub-id pub-id-type="pmid">22089434</pub-id></element-citation></ref><ref id="b26"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mlisana</surname><given-names>K</given-names></name><name><surname>Werner</surname><given-names>L</given-names></name><name><surname>Garrett</surname><given-names>NJ</given-names></name><etal></etal></person-group><article-title>Rapid disease progression in HIV-1 subtype C-infected South African women</article-title><source>Clin Infect Dis</source><year>2014</year><volume>59</volume><fpage>1322</fpage><lpage>1331</lpage><pub-id pub-id-type="pmid">25038116</pub-id></element-citation></ref><ref id="b27"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Babiker</surname><given-names>AG</given-names></name><name><surname>Emery</surname><given-names>S</given-names></name><name><surname>Fatkenheuer</surname><given-names>G</given-names></name><etal></etal></person-group><article-title>Considerations in the rationale, design and methods of the Strategic Timing of AntiRetroviral Treatment (START) study</article-title><source>Clin Trials</source><year>2013</year><volume>10</volume><fpage>S5</fpage><lpage>S36</lpage><pub-id pub-id-type="pmid">22547421</pub-id></element-citation></ref><ref id="b28"><element-citation publication-type="other"><collab>French National Agency for Research on AIDS and Viral Hepatitis</collab><comment>Early Antiretroviral Treatment and/or Early Isoniazid Prophylaxis Against Tuberculosis in HIV-infected Adults (ANRS 12136 TEMPRANO). Available at <ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov/show/NCT00495651">http://clinicaltrials.gov/show/NCT00495651</ext-link> (accessed 14 February 2014)</comment></element-citation></ref><ref id="b29"><element-citation publication-type="book"><collab>World Health Organization</collab><source>Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations</source><year>2014</year><publisher-loc>Geneva, Switzerland</publisher-loc><publisher-name>World Health Organization</publisher-name></element-citation></ref><ref id="b30"><element-citation publication-type="other"><collab>Department of Health</collab><comment>Republic of South Africa. Health budget vote speech by the Minister of Health, Dr Aaron Motsoaledi, MP. Available at <ext-link ext-link-type="uri" xlink:href="http://www.health.gov.za/docs/media/MinisterHealthBudgetVoteSpeech24July2014.pdf">http://www.health.gov.za/docs/media/MinisterHealthBudgetVoteSpeech24July2014.pdf</ext-link> (accessed 13 October 2014)</comment></element-citation></ref><ref id="b31"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Anglaret</surname><given-names>X</given-names></name><name><surname>Scott</surname><given-names>CA</given-names></name><name><surname>Walensky</surname><given-names>RP</given-names></name><etal></etal></person-group><article-title>Could early antiretroviral therapy entail more risks than benefits in sub-Saharan African HIV-infected adults? A model-based analysis</article-title><source>Antivir Ther</source><year>2013</year><volume>18</volume><fpage>45</fpage><lpage>55</lpage><pub-id pub-id-type="pmid">22809695</pub-id></element-citation></ref><ref id="b32"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Fox</surname><given-names>MP</given-names></name><name><surname>Cutsem</surname><given-names>GV</given-names></name><name><surname>Giddy</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Rates and predictors of failure of first-line antiretroviral therapy and switch to second-line ART in South Africa</article-title><source>J Acquir Immune Defic Syndr</source><year>2012</year><volume>60</volume><fpage>428</fpage><lpage>437</lpage><pub-id pub-id-type="pmid">22433846</pub-id></element-citation></ref><ref id="b33"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mutevedzi</surname><given-names>PC</given-names></name><name><surname>Lessells</surname><given-names>RJ</given-names></name><name><surname>Newell</surname><given-names>ML</given-names></name></person-group><article-title>Disengagement from care in a decentralised primary health care antiretroviral treatment programme: cohort study in rural South Africa</article-title><source>Trop Med Int Health</source><year>2013</year><volume>18</volume><fpage>934</fpage><lpage>941</lpage><pub-id pub-id-type="pmid">23731253</pub-id></element-citation></ref><ref id="b34"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nglazi</surname><given-names>MD</given-names></name><name><surname>Lawn</surname><given-names>SD</given-names></name><name><surname>Kaplan</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>Changes in programmatic outcomes during 7 years of scale-up at a community-based antiretroviral treatment service in South Africa</article-title><source>J Acquir Immune Defic Syndr</source><year>2011</year><volume>56</volume><fpage>e1</fpage><lpage>e8</lpage><pub-id pub-id-type="pmid">21084996</pub-id></element-citation></ref><ref id="b35"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Holmes</surname><given-names>CB</given-names></name><name><surname>Wood</surname><given-names>R</given-names></name><name><surname>Badri</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>CD4 decline and incidence of opportunistic infections in Cape Town, South Africa: implications for prophylaxis and treatment</article-title><source>J Acquir Immune Defic Syndr</source><year>2006</year><volume>42</volume><fpage>464</fpage><lpage>469</lpage><pub-id pub-id-type="pmid">16810113</pub-id></element-citation></ref><ref id="b36"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Iwuji</surname><given-names>CC</given-names></name><name><surname>Orne-Gliemann</surname><given-names>J</given-names></name><name><surname>Tanser</surname><given-names>F</given-names></name><etal></etal></person-group><article-title>Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial</article-title><source>Trials</source><year>2013</year><volume>14</volume><fpage>230</fpage><pub-id pub-id-type="pmid">23880306</pub-id></element-citation></ref><ref id="b37"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Vermund</surname><given-names>SH</given-names></name><name><surname>Fidler</surname><given-names>SJ</given-names></name><name><surname>Ayles</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Can Combination Prevention Strategies Reduce HIV Transmission in Generalized Epidemic Settings in Africa? The HPTN 071 (PopART) Study Plan in South Africa and Zambia</article-title><source>JAIDS Journal of Acquired Immune Deficiency Syndromes</source><year>2013</year><volume>63</volume><fpage>S221</fpage><lpage>S227</lpage><comment>210.1097/QAI.1090b1013e318299c318293f318294</comment></element-citation></ref><ref id="b38"><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Plazy</surname><given-names>M</given-names></name><name><surname>Dray-Spira</surname><given-names>R</given-names></name><name><surname>Orne-Gliemann</surname><given-names>J</given-names></name><name><surname>Dabis</surname><given-names>F</given-names></name><name><surname>Newell</surname><given-names>ML</given-names></name></person-group><collab>South Africa</collab><article-title>Continuum in HIV care from entry to ART initiation in rural KwaZulu-Natal</article-title><source>Trop Med Int Health</source><year>2014</year><volume>19</volume><fpage>680</fpage><lpage>689</lpage><pub-id pub-id-type="pmid">24654990</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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