Changing mortality risk associated with CD4 cell response to antiretroviral therapy in South Africa
Identifieur interne : 005437 ( Main/Merge ); précédent : 005436; suivant : 005438Changing mortality risk associated with CD4 cell response to antiretroviral therapy in South Africa
Auteurs : Stephen D. Lawn [Afrique du Sud, Royaume-Uni] ; Francesca Little [Afrique du Sud] ; Linda-Gail Bekker [Afrique du Sud] ; Richard Kaplan [Afrique du Sud] ; Elizabeth Campbel [Afrique du Sud] ; Catherine Orrell [Afrique du Sud] ; Robin Wood [Afrique du Sud]Source :
- AIDS (London, England) [ 0269-9370 ] ; 2009.
Abstract
To determine the relationship between mortality risk and the CD4 cell response to antiretroviral therapy (ART).
Observational community-based ART cohort in South Africa.
CD4 cell counts were measured 4 monthly, and deaths were prospectively ascertained. Cumulative person-time accrued within a range of updated CD4 cell count strata (CD4 cell-strata) was calculated and used to derive CD4 cell-stratified mortality rates.
Patients (2423) (median baseline CD4 cell count of 105 cells/ml) were observed for up to 5 years of ART. One hundred and ninety-seven patients died during 3155 person years of observation. In multivariate analysis, mortality rate ratios associated with 0–49, 50–99, 100–199, 200–299, 300– 399, 400–499 and at least 500 cells/ml updated CD4 cell-strata were 11.6, 4.9, 2.6, 1.7, 1.5, 1.4 and 1.0, respectively. Analysis of CD4 cell count recovery permitted calculations of person-time accrued within these CD4 cell strata. Despite rapid immune recovery, high mortality in the first year of ART was related to the large proportion of person-time accrued within CD4 cell-strata less than 200 cells/ml. Moreover, patients with baseline CD4 cell counts less than 100 cells/ml had much higher cumulative mortality estimates at 1 and 4 years (11.6 and 16.7%) compared with those of patients with baseline counts of at least 100 cells/ml (5.2 and 9.5%) largely because of greater cumulative person-time at CD4 cell counts less than 200 cells/ml. Conclusion: Updated CD4 cell counts are the variable most strongly associated with mortality risk during ART. High cumulative mortality risk is associated with person-time accrued at low CD4 cell counts. National HIV programmes in resource-limited settings should be designed to minimize the time patients spend with CD4 cell counts less than 200 cells/ml both before and during ART.
Url:
DOI: 10.1097/QAD.0b013e328321823f
PubMed: 19114870
PubMed Central: 3776050
Links toward previous steps (curation, corpus...)
- to stream Pmc, to step Corpus: 001D38
- to stream Pmc, to step Curation: 001D37
- to stream Pmc, to step Checkpoint: 002862
- to stream Ncbi, to step Merge: 000667
- to stream Ncbi, to step Curation: 000667
- to stream Ncbi, to step Checkpoint: 000667
Links to Exploration step
PMC:3776050Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Changing mortality risk associated with CD4 cell response to antiretroviral therapy in South Africa</title>
<author><name sortKey="Lawn, Stephen D" sort="Lawn, Stephen D" uniqKey="Lawn S" first="Stephen D." last="Lawn">Stephen D. Lawn</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="A2">Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Little, Francesca" sort="Little, Francesca" uniqKey="Little F" first="Francesca" last="Little">Francesca Little</name>
<affiliation wicri:level="1"><nlm:aff id="A3">Faculty of Science, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Faculty of Science, Department of Statistical Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Bekker, Linda Gail" sort="Bekker, Linda Gail" uniqKey="Bekker L" first="Linda-Gail" last="Bekker">Linda-Gail Bekker</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Kaplan, Richard" sort="Kaplan, Richard" uniqKey="Kaplan R" first="Richard" last="Kaplan">Richard Kaplan</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Campbel, Elizabeth" sort="Campbel, Elizabeth" uniqKey="Campbel E" first="Elizabeth" last="Campbel">Elizabeth Campbel</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Orrell, Catherine" sort="Orrell, Catherine" uniqKey="Orrell C" first="Catherine" last="Orrell">Catherine Orrell</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">19114870</idno>
<idno type="pmc">3776050</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776050</idno>
<idno type="RBID">PMC:3776050</idno>
<idno type="doi">10.1097/QAD.0b013e328321823f</idno>
<date when="2009">2009</date>
<idno type="wicri:Area/Pmc/Corpus">001D38</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001D38</idno>
<idno type="wicri:Area/Pmc/Curation">001D37</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001D37</idno>
<idno type="wicri:Area/Pmc/Checkpoint">002862</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002862</idno>
<idno type="wicri:Area/Ncbi/Merge">000667</idno>
<idno type="wicri:Area/Ncbi/Curation">000667</idno>
<idno type="wicri:Area/Ncbi/Checkpoint">000667</idno>
<idno type="wicri:doubleKey">0269-9370:2009:Lawn S:changing:mortality:risk</idno>
<idno type="wicri:Area/Main/Merge">005437</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Changing mortality risk associated with CD4 cell response to antiretroviral therapy in South Africa</title>
<author><name sortKey="Lawn, Stephen D" sort="Lawn, Stephen D" uniqKey="Lawn S" first="Stephen D." last="Lawn">Stephen D. Lawn</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="A2">Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Little, Francesca" sort="Little, Francesca" uniqKey="Little F" first="Francesca" last="Little">Francesca Little</name>
<affiliation wicri:level="1"><nlm:aff id="A3">Faculty of Science, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>Faculty of Science, Department of Statistical Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Bekker, Linda Gail" sort="Bekker, Linda Gail" uniqKey="Bekker L" first="Linda-Gail" last="Bekker">Linda-Gail Bekker</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Kaplan, Richard" sort="Kaplan, Richard" uniqKey="Kaplan R" first="Richard" last="Kaplan">Richard Kaplan</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Campbel, Elizabeth" sort="Campbel, Elizabeth" uniqKey="Campbel E" first="Elizabeth" last="Campbel">Elizabeth Campbel</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Orrell, Catherine" sort="Orrell, Catherine" uniqKey="Orrell C" first="Catherine" last="Orrell">Catherine Orrell</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name>
<affiliation wicri:level="1"><nlm:aff id="A1">The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town</wicri:regionArea>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">AIDS (London, England)</title>
<idno type="ISSN">0269-9370</idno>
<idno type="eISSN">1473-5571</idno>
<imprint><date when="2009">2009</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title>
<p id="P1">To determine the relationship between mortality risk and the CD4 cell response to antiretroviral therapy (ART).</p>
</sec>
<sec id="S2"><title>Design</title>
<p id="P2">Observational community-based ART cohort in South Africa.</p>
</sec>
<sec id="S3"><title>Methods</title>
<p id="P3">CD4 cell counts were measured 4 monthly, and deaths were prospectively ascertained. Cumulative person-time accrued within a range of updated CD4 cell count strata (CD4 cell-strata) was calculated and used to derive CD4 cell-stratified mortality rates.</p>
</sec>
<sec id="S4"><title>Results</title>
<p id="P4">Patients (2423) (median baseline CD4 cell count of 105 cells/ml) were observed for up to 5 years of ART. One hundred and ninety-seven patients died during 3155 person years of observation. In multivariate analysis, mortality rate ratios associated with 0–49, 50–99, 100–199, 200–299, 300– 399, 400–499 and at least 500 cells/ml updated CD4 cell-strata were 11.6, 4.9, 2.6, 1.7, 1.5, 1.4 and 1.0, respectively. Analysis of CD4 cell count recovery permitted calculations of person-time accrued within these CD4 cell strata. Despite rapid immune recovery, high mortality in the first year of ART was related to the large proportion of person-time accrued within CD4 cell-strata less than 200 cells/ml. Moreover, patients with baseline CD4 cell counts less than 100 cells/ml had much higher cumulative mortality estimates at 1 and 4 years (11.6 and 16.7%) compared with those of patients with baseline counts of at least 100 cells/ml (5.2 and 9.5%) largely because of greater cumulative person-time at CD4 cell counts less than 200 cells/ml. Conclusion: Updated CD4 cell counts are the variable most strongly associated with mortality risk during ART. High cumulative mortality risk is associated with person-time accrued at low CD4 cell counts. National HIV programmes in resource-limited settings should be designed to minimize the time patients spend with CD4 cell counts less than 200 cells/ml both before and during ART.</p>
</sec>
</div>
</front>
</TEI>
</record>
Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Main/Merge
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 005437 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Merge/biblio.hfd -nk 005437 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien |wiki= Wicri/Sante |area= SidaSubSaharaV1 |flux= Main |étape= Merge |type= RBID |clé= PMC:3776050 |texte= Changing mortality risk associated with CD4 cell response to antiretroviral therapy in South Africa }}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Main/Merge/RBID.i -Sk "pubmed:19114870" \ | HfdSelect -Kh $EXPLOR_AREA/Data/Main/Merge/biblio.hfd \ | NlmPubMed2Wicri -a SidaSubSaharaV1
This area was generated with Dilib version V0.6.32. |