CD4 count recovery and associated factors among individuals enrolled in the South African antiretroviral therapy programme: An analysis of national laboratory based data

doi:10.1371/journal.pone.0217742

. 2019 May 31;14(5):e0217742.

doi: 10.1371/journal.pone.0217742. eCollection 2019.

CD4 count recovery and associated factors among individuals enrolled in the South African antiretroviral therapy programme: An analysis of national laboratory based data

Tendesayi Kufa^{1

2}, Zara Shubber³, William MacLeod^{4

5}, Simbarashe Takuva⁶, Sergio Carmona⁷, Jacob Bor⁴, Marelize Gorgens³, Yogan Pillay⁸, Adrian Puren^{1

9}, Jeffrey W Eaton¹⁰, Nicole Fraser-Hurt³

Affiliations

¹ Centre for HIV and STIs, National Institute of Communicable Diseases, Sandringham, Johannesburg, South Africa.
² The School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ The World Bank Group, Washington D.C., United States of America.
⁴ Department of Global Health, Boston University School of Public Health, Boston, United States of America.
⁵ Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ National Priority Programmes, National Health Laboratory Services, Sandringham, Johannesburg, South Africa.
⁸ National Department of Health, Pretoria, South Africa.
⁹ Division of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁰ Department of Infectious Diseases Epidemiology, Imperial College, London, United Kingdom.

PMID: 31150489
PMCID: PMC6544279
DOI: 10.1371/journal.pone.0217742

CD4 count recovery and associated factors among individuals enrolled in the South African antiretroviral therapy programme: An analysis of national laboratory based data

Tendesayi Kufa et al. PLoS One. 2019.

. 2019 May 31;14(5):e0217742.

doi: 10.1371/journal.pone.0217742. eCollection 2019.

Authors

Affiliations

¹ Centre for HIV and STIs, National Institute of Communicable Diseases, Sandringham, Johannesburg, South Africa.
² The School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³ The World Bank Group, Washington D.C., United States of America.
⁴ Department of Global Health, Boston University School of Public Health, Boston, United States of America.
⁵ Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ National Priority Programmes, National Health Laboratory Services, Sandringham, Johannesburg, South Africa.
⁸ National Department of Health, Pretoria, South Africa.
⁹ Division of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁰ Department of Infectious Diseases Epidemiology, Imperial College, London, United Kingdom.

PMID: 31150489
PMCID: PMC6544279
DOI: 10.1371/journal.pone.0217742

Abstract

Background: We describe CD4 count recovery among HIV positive individuals who initiated antiretroviral therapy (ART) with and without severe immune suppression using complete laboratory data from South Africa's national HIV treatment programme between 2010 and 2014 and discuss implications for CD4 count monitoring.

Methods: Retrospective analysis of routinely collected laboratory data from South Africa's National Health Laboratory Service (NHLS). A probabilistic record linkage algorithm was used to create a cohort of HIV positive individuals who initiated ART between 2010 and 2014 based on timing of CD4 count and viral load measurements. A CD4 count < 50 copies/μl at ART initiation was considered severe immunosuppression. A multivariable piecewise mixed-effects linear regression model adjusting for age, gender, year of starting ART, viral suppression in follow up and province was used to predict CD4 counts during follow up.

Results: 1,070,900 individuals had evidence of starting ART during 2010-2014 and met the criteria for inclusion in the cohort -46.6% starting ART with CD4 < 200 cells/μl and 10.1% with CD4 < 50 cells/ μl. For individuals with CD4 counts < 200 cells/μl, predicted CD4 counts > 200 cells/μl, >350 cells/μl and >500 cells/μl corresponded with mean follow up durations of 1.5 years (standard deviation [s.d] 1.1), 1.9years (s.d 1.2) and 2.1 years (s.d 1.3 years). For those with CD4 counts < 50 cells/μl, predicted CD4 count above these threshold corresponded with mean follow up durations of 2.5 years (s.d 0.9 years), 4.4 years (s.d 0.4 years) and 5.0 years (s.d 0.1years) for recovery to the same thresholds. CD4 count recovery varied mostly with duration on ART, CD4 count at the start of ART and gender.

Conclusion: For individuals starting with ART with severe immunosuppression, CD4 recovery to 200cells/μl did not occur or took longer than 12 month for significant proportions. CD4 monitoring and interventions recommended for advanced HIV disease should continue until full recovery.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**Fig 2. Observed and predicted CD4 counts at different durations on ART.**

**Fig 3. Predicted CD4 counts among those with or without viral suppression during follow up.**

See this image and copyright information in PMC

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References

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[1] May M, Sterne JA, Sabin C, Costagliola D, Justice AC, Thiebaut R. et al. (2007) Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies. AIDS 21: 1185–1197. 10.1097/QAD.0b013e328133f285 - DOI - PMC - PubMed

[2] May M, Sterne JA, Sabin C, Costagliola D, Justice AC, Thiebaut R. et al. (2007) Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies. AIDS 21: 1185–1197. 10.1097/QAD.0b013e328133f285 - DOI - PMC - PubMed

[3] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Hakim J. G.et al. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365: 493–505. 10.1056/NEJMoa1105243 - DOI - PMC - PubMed

[4] Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Hakim J. G.et al. (2011) Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365: 493–505. 10.1056/NEJMoa1105243 - DOI - PMC - PubMed

[5] Tanser F, Barnighausen T, Grapsa E, Zaidi J, Newell ML (2013) High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Science 339: 966–971. 10.1126/science.1228160 - DOI - PMC - PubMed

[6] Tanser F, Barnighausen T, Grapsa E, Zaidi J, Newell ML (2013) High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Science 339: 966–971. 10.1126/science.1228160 - DOI - PMC - PubMed

[7] Kaufmann GR, Bloch M, Zaunders JJ, Smith D, Cooper DA (2000) Long-term immunological response in HIV-1-infected subjects receiving potent antiretroviral therapy. Aids 14: 959–969. - PubMed

[8] Kaufmann GR, Bloch M, Zaunders JJ, Smith D, Cooper DA (2000) Long-term immunological response in HIV-1-infected subjects receiving potent antiretroviral therapy. Aids 14: 959–969. - PubMed

[9] Gaardbo JC, Hartling HJ, Gerstoft J, Nielsen SD (2012) Incomplete immune recovery in HIV infection: mechanisms, relevance for clinical care, and possible solutions. Clin Dev Immunol 2012: 670957. - PMC - PubMed

[10] Gaardbo JC, Hartling HJ, Gerstoft J, Nielsen SD (2012) Incomplete immune recovery in HIV infection: mechanisms, relevance for clinical care, and possible solutions. Clin Dev Immunol 2012: 670957. - PMC - PubMed

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CD4 count recovery and associated factors among individuals enrolled in the South African antiretroviral therapy programme: An analysis of national laboratory based data

Affiliations

CD4 count recovery and associated factors among individuals enrolled in the South African antiretroviral therapy programme: An analysis of national laboratory based data

Authors

Affiliations

Abstract

Conflict of interest statement

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