Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients

Sasisopin Kiertiburanakul, David Boettiger, Man Po Lee, Sharifah Fs Omar, Junko Tanuma, Oon Tek Ng, Nicolas Durier, Praphan Phanuphak, Rossana Ditangco, Romanee Chaiwarith, Pacharee Kantipong, Christopher Kc Lee, Mahiran Mustafa, Vonthanak Saphonn, Winai Ratanasuwan, Tuti Parwati Merati, Nagalingeswaran Kumarasamy, Wing Wai Wong, Fujie Zhang, Thanh Thuy PhamSanjay Pujari, Jun Yong Choi, Evy Yunihastuti, Somnuek Sungkanuparph

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Abstract

Introduction: Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation. Methods: Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm 3 or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined. Results: A total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46-241) cells/mm3. Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm3 in 2008 to a peak of 302 cells/mm3 after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27-0.59; p <0.001), sex (male vs. female; OR 1.51, 95% CI 1.18-1.93; p = 0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24-2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77-5.21; p <0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19-3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31-3.43; p = 0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18-7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1. -4.36; p = 0.035). Conclusions: Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented.

Original languageEnglish
Article number18804
JournalJournal of the International AIDS Society
Volume17
DOIs
Publication statusPublished - 2014 Mar 14

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CD4 Lymphocyte Count
HIV
Therapeutics
Mortality
Heterosexuality
Hepatitis C

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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Kiertiburanakul, Sasisopin ; Boettiger, David ; Lee, Man Po ; Omar, Sharifah Fs ; Tanuma, Junko ; Ng, Oon Tek ; Durier, Nicolas ; Phanuphak, Praphan ; Ditangco, Rossana ; Chaiwarith, Romanee ; Kantipong, Pacharee ; Lee, Christopher Kc ; Mustafa, Mahiran ; Saphonn, Vonthanak ; Ratanasuwan, Winai ; Merati, Tuti Parwati ; Kumarasamy, Nagalingeswaran ; Wong, Wing Wai ; Zhang, Fujie ; Pham, Thanh Thuy ; Pujari, Sanjay ; Choi, Jun Yong ; Yunihastuti, Evy ; Sungkanuparph, Somnuek. / Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients. In: Journal of the International AIDS Society. 2014 ; Vol. 17.
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title = "Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients",
abstract = "Introduction: Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation. Methods: Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm 3 or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined. Results: A total of 2737 HIV-positive ART-na{\"i}ve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46-241) cells/mm3. Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm3 in 2008 to a peak of 302 cells/mm3 after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1{\%} before 2007 to 36.3{\%} after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95{\%} CI 0.27-0.59; p <0.001), sex (male vs. female; OR 1.51, 95{\%} CI 1.18-1.93; p = 0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95{\%} CI 1.24-2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95{\%} CI 1.77-5.21; p <0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95{\%} CI 1.19-3.79; p=0.010), sex (male vs. female; HR 2.12, 95{\%} CI 1.31-3.43; p = 0.002), age (≥51 vs. ≤30 years; HR 3.91, 95{\%} CI 2.18-7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95{\%} CI 1. -4.36; p = 0.035). Conclusions: Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented.",
author = "Sasisopin Kiertiburanakul and David Boettiger and Lee, {Man Po} and Omar, {Sharifah Fs} and Junko Tanuma and Ng, {Oon Tek} and Nicolas Durier and Praphan Phanuphak and Rossana Ditangco and Romanee Chaiwarith and Pacharee Kantipong and Lee, {Christopher Kc} and Mahiran Mustafa and Vonthanak Saphonn and Winai Ratanasuwan and Merati, {Tuti Parwati} and Nagalingeswaran Kumarasamy and Wong, {Wing Wai} and Fujie Zhang and Pham, {Thanh Thuy} and Sanjay Pujari and Choi, {Jun Yong} and Evy Yunihastuti and Somnuek Sungkanuparph",
year = "2014",
month = "3",
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doi = "10.7448/IAS.17.1.18804",
language = "English",
volume = "17",
journal = "Journal of the International AIDS Society",
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Kiertiburanakul, S, Boettiger, D, Lee, MP, Omar, SF, Tanuma, J, Ng, OT, Durier, N, Phanuphak, P, Ditangco, R, Chaiwarith, R, Kantipong, P, Lee, CK, Mustafa, M, Saphonn, V, Ratanasuwan, W, Merati, TP, Kumarasamy, N, Wong, WW, Zhang, F, Pham, TT, Pujari, S, Choi, JY, Yunihastuti, E & Sungkanuparph, S 2014, 'Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients', Journal of the International AIDS Society, vol. 17, 18804. https://doi.org/10.7448/IAS.17.1.18804

Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients. / Kiertiburanakul, Sasisopin; Boettiger, David; Lee, Man Po; Omar, Sharifah Fs; Tanuma, Junko; Ng, Oon Tek; Durier, Nicolas; Phanuphak, Praphan; Ditangco, Rossana; Chaiwarith, Romanee; Kantipong, Pacharee; Lee, Christopher Kc; Mustafa, Mahiran; Saphonn, Vonthanak; Ratanasuwan, Winai; Merati, Tuti Parwati; Kumarasamy, Nagalingeswaran; Wong, Wing Wai; Zhang, Fujie; Pham, Thanh Thuy; Pujari, Sanjay; Choi, Jun Yong; Yunihastuti, Evy; Sungkanuparph, Somnuek.

In: Journal of the International AIDS Society, Vol. 17, 18804, 14.03.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients

AU - Kiertiburanakul, Sasisopin

AU - Boettiger, David

AU - Lee, Man Po

AU - Omar, Sharifah Fs

AU - Tanuma, Junko

AU - Ng, Oon Tek

AU - Durier, Nicolas

AU - Phanuphak, Praphan

AU - Ditangco, Rossana

AU - Chaiwarith, Romanee

AU - Kantipong, Pacharee

AU - Lee, Christopher Kc

AU - Mustafa, Mahiran

AU - Saphonn, Vonthanak

AU - Ratanasuwan, Winai

AU - Merati, Tuti Parwati

AU - Kumarasamy, Nagalingeswaran

AU - Wong, Wing Wai

AU - Zhang, Fujie

AU - Pham, Thanh Thuy

AU - Pujari, Sanjay

AU - Choi, Jun Yong

AU - Yunihastuti, Evy

AU - Sungkanuparph, Somnuek

PY - 2014/3/14

Y1 - 2014/3/14

N2 - Introduction: Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation. Methods: Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm 3 or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined. Results: A total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46-241) cells/mm3. Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm3 in 2008 to a peak of 302 cells/mm3 after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27-0.59; p <0.001), sex (male vs. female; OR 1.51, 95% CI 1.18-1.93; p = 0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24-2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77-5.21; p <0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19-3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31-3.43; p = 0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18-7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1. -4.36; p = 0.035). Conclusions: Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented.

AB - Introduction: Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation. Methods: Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm 3 or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined. Results: A total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46-241) cells/mm3. Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm3 in 2008 to a peak of 302 cells/mm3 after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27-0.59; p <0.001), sex (male vs. female; OR 1.51, 95% CI 1.18-1.93; p = 0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24-2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77-5.21; p <0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19-3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31-3.43; p = 0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18-7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1. -4.36; p = 0.035). Conclusions: Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented.

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