title: The prognostic value of baseline CD4(+) cell count beyond 6 months of antiretroviral therapy in HIV-positive patients in a resource-limited setting.
abstract: OBJECTIVE
  The risk of death is highest in the first few months after initiation of antiretroviral therapy (ART). We examined whether initial CD4 cell count maintains a strong prognostic value among patients with at least 6 months follow-up after the initiation of ART.
  
  
  METHODS
  Observational study of HIV patients in Uganda aged 14 years or older enrolled in 10 clinics across Uganda.
  
  
  METHODS
  Baseline CD4 cell count of patients with more than 6 months of follow-up were stratified into categories (<50, 50-99, 100-149, 150-249, >250 cells/μl). A Kaplan-Meier survival analysis and Cox proportional hazards regression was used to model the associations between baseline CD4 cell count and mortality.
  
  
  RESULTS
  Of 22 315 patients, 20 730 (92.8%) had more than 6 months of follow-up. Six hundred and eleven (2.9%) patients died during follow-up and 737 (3.6%) were lost to follow-up. Relative to a baseline CD4 cell counts of less than 50 cells/μl, the adjusted hazard ratios for death were 0.83 [95% confidence interval (CI) 0.67-1.02], 0.71 (95% CI 0.57-0.88), 0.52 (95% CI 0.42-0.64), and 0.55 (95% CI 0.42-0.70) favouring those with baseline CD4 cell counts of 50-99, 100-149, 150-249, and at least 250 cells/μl, respectively. Differing ages and male sex increased the likelihood of mortality.
  
  
  CONCLUSIONS
  Among patients with more than 6 months of follow-up after initiation of ART, baseline CD4 cell count at initiation still has important prognostic value. This suggests that active engagement and earlier treatment initiation is important for long-term survival.
authors.affiliation: Faculty of Health Sciences, University of Ottawa, Ottawa, Canada. edward.mills@uottawa.ca
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.forename: Celestin
authors.initials: C
authors.lastname: Bakanda
authors.forename: Josephine
authors.initials: J
authors.lastname: Birungi
authors.forename: Sanni
authors.initials: S
authors.lastname: Yaya
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015497:HIV-1 / Q000276:immunology*; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D017678:Sex Distribution; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents