Immunodeficiency at the Start of Combination Antiretroviral Therapy in Low-, Middle-, and High-Income Countries

被引：128

作者：

Avila, Dorita ^{[1
]}

Althoff, Keri N. ^{[2
]}

Mugglin, Catrina ^{[1
]}

Wools-Kaloustian, Kara ^{[3
]}

Koller, Manuel ^{[1
]}

Dabis, Franois ^{[4
]}

Nash, Denis ^{[5
]}

Gsponer, Thomas ^{[1
]}

Sungkanuparph, Somnuek ^{[6
]}

McGowan, Catherine ^{[7
]}

May, Margaret ^{[8
]}

Cooper, David ^{[9
]}

Chimbetete, Cleophas ^{[10
]}

Wolff, Marcelo ^{[11
]}

Collier, Ann ^{[12
]}

McManus, Hamish ^{[9
]}

Davies, Mary-Ann ^{[13
,14
]}

Costagliola, Dominique ^{[15
]}

Crabtree-Ramirez, Brenda ^{[16
]}

Chaiwarith, Romanee ^{[17
]}

Cescon, Angela ^{[18
]}

Cornell, Morna ^{[13
,14
]}

Diero, Lameck ^{[19
]}

Phanuphak, Praphan ^{[20
]}

Sawadogo, Adrien ^{[21
]}

Ehmer, Jochen ^{[22
]}

Eholie, Serge P. ^{[23
]}

Li, Patrick C. K. ^{[24
]}

Fox, Matthew P. ^{[25
,26
,27
,28
]}

Gandhi, Neel R. ^{[29
,30
,31
]}

Gonzalez, Elsa ^{[32
]}

Lee, Christopher K. C. ^{[33
]}

Hoffmann, Christopher J. ^{[34
,35
]}

Kambugu, Andrew ^{[36
]}

Keiser, Olivia ^{[1
]}

Ditangco, Rossana ^{[37
]}

Prozesky, Hans ^{[38
,39
]}

Lampe, Fiona ^{[40
]}

Kumarasamy, Nagalingeswaran ^{[41
]}

Kitahata, Mari ^{[12
]}

Lugina, Emmanuel ^{[42
]}

Lyamuya, Rita ^{[43
]}

Vonthanak, Saphonn ^{[44
]}

Fink, Valeria ^{[45
]}

Monforte, Antonella d'Arminio ^{[46
]}

Luz, Paula Mendes ^{[47
]}

Chen, Yi-Ming A. ^{[48
,49
]}

Minga, Albert ^{[50
]}

Casabona, Jordi ^{[51
,52
]}

Mwango, Albert ^{[53
]}

机构：

[1] Univ Bern, Inst Social & Prevent Med, CH-3012 Bern, Switzerland

[2] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[3] Indiana Univ Sch Med, Indianapolis, IN 46202 USA

[4] Univ Bordeaux Segalen, ISPED, Bordeaux, France

[5] CUNY, Sch Publ Hlth, New York, NY 10021 USA

[6] Mahidol Univ, Ramathibodi Hosp, Fac Med, Bangkok 10400, Thailand

[7] Vanderbilt Univ, Sch Med, Nashville, TN 37212 USA

[8] Univ Bristol, Sch Social & Community Med, Bristol BS8 1TH, Avon, England

[9] Univ New S Wales, Kirby Inst, Sydney, NSW, Australia

[10] Newlands Clin, Harare, Zimbabwe

[11] Univ Chile, Fdn Arriaran, Santiago, Chile

[12] Univ Washington, Sch Med Ctr, Seattle, WA 98195 USA

[13] Univ Cape Town, Ctr Infect Dis Epidemiol & Res, ZA-7700 Rondebosch, South Africa

[14] Univ Cape Town, Sch Publ Hlth & Family Med, Div Epidemiol & Biostat, ZA-7700 Rondebosch, South Africa

[15] Univ Paris 06, UMR S 943, Paris, France

[16] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico

[17] Res Inst Hlth Sci, Chiang Mai, Thailand

[18] British Columbia Ctr Excellence HIV AIDS, Vancouver, BC, Canada

[19] Moi Univ, Sch Med, Coll Hlth Sci, Acad Model Providing Access Hlth Care AMPATH, Eldoret, Kenya

[20] HIV NAT Thai Red Cross AIDS Res Ctr, Bangkok, Thailand

[21] CHU Souro Sanou, Bobo Dioulasso, Burkina Faso

[22] SolidarMed African HIV Prevent & Treatment Progra, Luzern, Switzerland

[23] CHU Treichville, SMIT, Abidjan, Cote Ivoire

[24] Queen Elizabeth Hosp, Hong Kong, Hong Kong, Peoples R China

[25] Boston Univ, Ctr Global Hlth & Dev, Boston, MA 02215 USA

[26] Boston Univ, Dept Epidemiol, Boston, MA 02215 USA

[27] Boston Univ, Sch Publ Hlth, Boston, MA USA

[28] Univ Witwatersrand, Hlth Econ & Epidemiol Res Off, Johannesburg, South Africa

[29] Emory Univ, Rollins Sch Publ Hlth, Dept Epidemiol, Atlanta, GA 30322 USA

[30] Emory Univ, Rollins Sch Publ Hlth, Dept Global Hlth, Atlanta, GA 30322 USA

[31] Emory Univ, Rollins Sch Publ Hlth, Dept Infect Dis, Atlanta, GA 30322 USA

[32] Univ Peruana Cayetano Heredia, Inst Med Trop Alexander von Humboldt, Lima, Peru

[33] Hosp Sungai Buloh, Sungai Buloh, Malaysia

[34] Aurum Inst, Johannesburg, South Africa

[35] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[36] Infect Dis Inst, Kampala, Uganda

[37] Res Inst Trop Med, Manila, Philippines

[38] Univ Stellenbosch, Div Infect Dis, Cape Town, South Africa

[39] Tygerberg Hosp, Cape Town, South Africa

[40] UCL, Res Dept Infect & Populat Hlth, London WC1E 6BT, England

[41] YRG Ctr AIDS Res & Educ, Chennai, Tamil Nadu, India

[42] Ocean Rd Canc Inst, Dar Es Salaam, Tanzania

[43] Morogoro Reg Hosp, Morogoro, Tanzania

[44] Natl Ctr HIV AIDS Dermatol & STDs, Phnom Penh, Cambodia

[45] Fdn Huesped, Buenos Aires, DF, Argentina

[46] Univ Milan, San Paolo Hosp, Clin Infect Dis & Trop Med, I-20122 Milan, Italy

[47] Fundacao Oswaldo Cruz, Inst Pesquisa Clin Evandro Chagas, Rio De Janeiro, Brazil

[48] Taipei Vet Gen Hosp, Taipei, Taiwan

[49] Natl Yang Ming Univ, AIDS Prevent & Res Ctr, Taipei 112, Taiwan

[50] Ctr Med Suivi de Donneurs Sang CNTS PRIMO CI, Abidjan, Cote Ivoire

来源：

JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES | 2014年 / 65卷 / 01期

基金：

加拿大健康研究院; 英国医学研究理事会; 美国国家卫生研究院;

关键词：

sub-Saharan Africa; antiretroviral therapy; North America; CD4 cell count; Central and South America; Asia/Pacific; Europe; Carribean; INTERNATIONAL EPIDEMIOLOGIC DATABASES; EVALUATE AIDS IEDEA; SUB-SAHARAN AFRICA; CD4(+) CELL COUNT; COLLABORATIVE ANALYSIS; COHORT PROFILE; HIV-1-INFECTED PATIENTS; BASE-LINE; HIV; INITIATION;

D O I：

10.1097/QAI.0b013e3182a39979

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

071005 [微生物学]; 100108 [医学免疫学];

摘要：

Objective: To describe the CD4 cell count at the start of combination antiretroviral therapy (cART) in low-income (LIC), lower middle-income (LMIC), upper middle-income (UMIC), and high-income (HIC) countries. Methods: Patients aged 16 years or older starting cART in a clinic participating in a multicohort collaboration spanning 6 continents (International epidemiological Databases to Evaluate AIDS and ART Cohort Collaboration) were eligible. Multilevel linear regression models were adjusted for age, gender, and calendar year; missing CD4 counts were imputed. Results: In total, 379,865 patients from 9 LIC, 4 LMIC, 4 UMIC, and 6 HIC were included. In LIC, the median CD4 cell count at cART initiation increased by 83% from 80 to 145 cells/mu L between 2002 and 2009. Corresponding increases in LMIC, UMIC, and HIC were from 87 to 155 cells/mu L (76% increase), 88 to 135 cells/mu L (53%), and 209 to 274 cells/mu L (31%). In 2009, compared with LIC, median counts were 13 cells/mu L [95% confidence interval (CI): -56 to +30] lower in LMIC, 22 cells/mu L (-62 to +18) lower in UMIC, and 112 cells/mu L (+75 to +149) higher in HIC. They were 23 cells/mu L (95% CI: +18 to +28 cells/mu L) higher in women than men. Median counts were 88 cells/mu L (95% CI: +35 to +141 cells/mu L) higher in countries with an estimated national cART coverage >80%, compared with countries with Conclusions: Median CD4 cell counts at the start of cART increased 2000-2009 but remained below 200 cells/mu L in LIC and MIC and below 300 cells/mu L in HIC. Earlier start of cART will require substantial efforts and resources globally.

引用

页码：E8 / E16

页数：9

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