title: Mortality, AIDS-morbidity, and loss to follow-up by current CD4 cell count among HIV-1-infected adults receiving antiretroviral therapy in Africa and Asia: data from the ANRS 12222 collaboration.
abstract: BACKGROUND
  In resource-limited countries, estimating CD4-specific incidence rates of mortality and morbidity among patients receiving antiretroviral therapy (ART) may help assess the effectiveness of care and treatment programmes, identify program weaknesses, and inform decisions.
  
  
  METHODS
  We pooled data from 13 research cohorts in 5 sub-Saharan African (Benin, Burkina Faso, Cameroon, Cote d'Ivoire, and Senegal) and 2 Asian (Cambodia and Laos) countries. HIV-infected adults (18 years and older) who received ART in 1998-2008 and had at least one CD4 count available were eligible. Changes in CD4 counts over time were estimated by a linear mixed regression. CD4-specific incidence rates were estimated as the number of first events occurring in a given CD4 stratum divided by the time spent within the stratum.
  
  
  RESULTS
  Overall 3917 adults (62% women) on ART were followed up during 10,154 person-years. In the ≤ 50, 51-100, 101-200, 201-350, 351-500, 501-650, and >650 cells/mm CD4 cells strata, death rates were 20.6, 11.8, 6.7, 3.3, 1.8, 0.9, and 0.3 per 100 person-years; AIDS rates were 50.5, 32.9, 11.5, 4.8, 2.8, 2.2, and 2.2 per 100 person-years; and loss-to-follow-up rates were 4.9, 6.1, 3.5, 3.1, 2.9, 1.7, and 1.2 per 100 person-years, respectively. Mortality and morbidity were higher during the first year after ART initiation.
  
  
  CONCLUSIONS
  In these resource-limited settings, death and AIDS rates remained substantial after ART initiation, even in individuals with high CD4 cell counts. Ensuring earlier ART initiation and optimizing case finding and treatment for AIDS-defining diseases should be seen as priorities.
authors.affiliation: INSERM, U897, Université Bordeaux Segalen, Bordeaux, France. delphine.gabillard@isped.u-bordeaux2.fr
authors.forename: Delphine
authors.initials: D
authors.lastname: Gabillard
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.forename: Ibra
authors.initials: I
authors.lastname: Ndoye
authors.forename: Raoul
authors.initials: R
authors.lastname: Moh
authors.forename: Olivier
authors.initials: O
authors.lastname: Segeral
authors.forename: Besigin
authors.initials: B
authors.lastname: Tonwe-Gold
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
authors.forename: Men
authors.initials: M
authors.lastname: Pagnaroat
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fournier-Nicolle
authors.forename: Serge
authors.initials: S
authors.lastname: Eholié
authors.forename: Issouf
authors.initials: I
authors.lastname: Konate
authors.forename: Albert
authors.initials: A
authors.lastname: Minga
authors.forename: Eitel
authors.initials: E
authors.lastname: Mpoudi-Ngole
authors.forename: Sinata
authors.initials: S
authors.lastname: Koulla-Shiro
authors.forename: Djimon Marcel
authors.initials: DM
authors.lastname: Zannou
authors.forename: Xavier
authors.initials: X
authors.lastname: Anglaret
authors.forename: Christian
authors.initials: C
authors.lastname: Laurent
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents