CD4(+) T cell count decreases by ethnicity among untreated patients with HIV infection in South Africa and Switzerland.
BACKGROUND
Estimates of the decrease in CD4(+) cell counts in untreated patients with human immunodeficiency virus (HIV) infection are important for patient care and public health. We analyzed CD4(+) cell count decreases in the Cape Town AIDS Cohort and the Swiss HIV Cohort Study.


METHODS
We used mixed-effects models and joint models that allowed for the correlation between CD4(+) cell count decreases and survival and stratified analyses by the initial cell count (50-199, 200-349, 350-499, and 500-750 cells/microL). Results are presented as the mean decrease in CD4(+) cell count with 95% confidence intervals (CIs) during the first year after the initial CD4(+) cell count.


RESULTS
A total of 784 South African (629 nonwhite) and 2030 Swiss (218 nonwhite) patients with HIV infection contributed 13,388 CD4(+) cell counts. Decreases in CD4(+) cell count were steeper in white patients, patients with higher initial CD4(+) cell counts, and older patients. Decreases ranged from a mean of 38 cells/microL (95% CI, 24-54 cells/microL) in nonwhite patients from the Swiss HIV Cohort Study 15-39 years of age with an initial CD4(+) cell count of 200-349 cells/microL to a mean of 210 cells/microL (95% CI, 143-268 cells/microL) in white patients in the Cape Town AIDS Cohort > or =40 years of age with an initial CD4(+) cell count of 500-750 cells/microL.


CONCLUSIONS
Among both patients from Switzerland and patients from South Africa, CD4(+) cell count decreases were greater in white patients with HIV infection than they were in nonwhite patients with HIV infection.
Department of Social Medicine, University of Bristol, United Kingdom. m.t.may@bristol.ac.uk
Margaret
M
May
Robin
R
Wood
Landon
L
Myer
Patrick
P
Taffé
Andri
A
Rauch
Manuel
M
Battegay
Matthias
M
Egger
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology* / Q000276:immunology*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D013019:South Africa / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology