title: Population-based CD4 counts in a rural area in South Africa with high HIV prevalence and high antiretroviral treatment coverage.
abstract: BACKGROUND
  Little is known about the variability of CD4 counts in the general population of sub-Saharan Africa countries affected by the HIV epidemic. We investigated factors associated with CD4 counts in a rural area in South Africa with high HIV prevalence and high antiretroviral treatment (ART) coverage.
  
  
  METHODS
  CD4 counts, health status, body mass index (BMI), demographic characteristics and HIV status were assessed in 4990 adult resident participants of a demographic surveillance in rural KwaZulu-Natal in South Africa; antiretroviral treatment duration was obtained from a linked clinical database. Multivariable regression analysis, overall and stratified by HIV status, was performed with CD4 count levels as outcome.
  
  
  RESULTS
  Median CD4 counts were significantly higher in women than in men overall (714 vs. 630 cells/µl, p<0.0001), both in HIV-uninfected (833 vs. 683 cells/µl, p<0.0001) and HIV-infected adults (384.5 vs. 333 cells/µl, p<0.0001). In multivariable regression analysis, women had 19.4% (95% confidence interval (CI) 16.1-22.9) higher CD4 counts than men, controlling for age, HIV status, urban/rural residence, household wealth, education, BMI, self-reported tuberculosis, high blood pressure, other chronic illnesses and sample processing delay. At ART initiation, HIV-infected adults had 21.7% (95% CI 14.6-28.2) lower CD4 counts than treatment-naive individuals; CD4 counts were estimated to increase by 9.2% (95% CI 6.2-12.4) per year of treatment.
  
  
  CONCLUSIONS
  CD4 counts are primarily determined by sex in HIV-uninfected adults, and by sex, age and duration of antiretroviral treatment in HIV-infected adults. Lower CD4 counts at ART initiation in men could be a consequence of lower CD4 cell counts before HIV acquisition.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, KwaZulu-Natal, South Africa.
authors.forename: Abraham
authors.initials: A
authors.lastname: Malaza
authors.forename: Joël
authors.initials: J
authors.lastname: Mossong
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
authors.forename: Johannes
authors.initials: J
authors.lastname: Viljoen
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population; D012737:Sex Factors; D013019:South Africa / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents
references.citation: J Clin Immunol. 2005 Mar;25(2):127-33
references.pmid: 15821889
references.citation: J Allergy Clin Immunol. 2010 Jan;125(1):203-8
references.pmid: 19944455
references.citation: AIDS. 2009 Aug 24;23(13):1717-25
references.pmid: 19461502
references.citation: Clin Vaccine Immunol. 2009 Sep;16(9):1374-7
references.pmid: 19641097
references.citation: PLoS One. 2011;6(6):e21040
references.pmid: 21713038
references.citation: BMC Infect Dis. 2009 Jan 13;9:1
references.pmid: 19144106
references.citation: AIDS. 1999 Feb 25;13(3):381-9
references.pmid: 10199229
references.citation: J Clin Immunol. 1989 May;9(3):214-22
references.pmid: 2788656
references.citation: AIDS. 2000 Sep 29;14(14):2083-92
references.pmid: 11061648
references.citation: J Acquir Immune Defic Syndr. 2014 Jan 1;65(1):e17-24
references.pmid: 23756374
references.citation: Trop Med Int Health. 2012 Aug;17(8):e103-10
references.pmid: 22943374
references.citation: Am J Clin Pathol. 2010 Oct;134(4):556-67
references.pmid: 20855636
references.citation: Clin Vaccine Immunol. 2007 Jun;14(6):782-4
references.pmid: 17442846
references.citation: AIDS. 1993 Nov;7(11):1401-10
references.pmid: 8280406
references.citation: AIDS. 2001 May 25;15(8):983-90
references.pmid: 11399980
references.citation: PLoS One. 2012;7(2):e31161
references.pmid: 22348047
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Jan 1;14(1):82-3
references.pmid: 8989218
references.citation: BMC Int Health Hum Rights. 2012 Apr 10;12:3
references.pmid: 22490444
references.citation: J Infect Dis. 2006 Nov 15;194(10):1450-8
references.pmid: 17054076
references.citation: Int J STD AIDS. 1996 Jul;7(4):288-91
references.pmid: 8876362
references.citation: J Infect Dis. 2002 Apr 1;185(7):905-14
references.pmid: 11920314
references.citation: PLoS Med. 2012;9(9):e1001304
references.pmid: 22973181
references.citation: Clin Immunol. 2003 Dec;109(3):338-46
references.pmid: 14697749
references.citation: AIDS. 2004 Feb 20;18(3):433-8
references.pmid: 15090795
references.citation: Scand J Immunol. 2012 Jul;76(1):33-8
references.pmid: 22686509
references.citation: Int J Epidemiol. 1997 Dec;26(6):1367-72
references.pmid: 9447419
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Dec 1;13(4):355-62
references.pmid: 8948374
references.citation: Arch Intern Med. 2000 Mar 13;160(5):715-6
references.pmid: 10724063
references.citation: Clin Diagn Lab Immunol. 1995 Mar;2(2):233-5
references.pmid: 7697535
references.citation: Clin Diagn Lab Immunol. 2005 Apr;12(4):525-30
references.pmid: 15817761
references.citation: J Acquir Immune Defic Syndr. 2004 May 1;36(1):613-21
references.pmid: 15097305
references.citation: Cytometry B Clin Cytom. 2006 May;70(3):163-9
references.pmid: 16498672
references.citation: AIDS. 2005 Mar 24;19(6):577-83
references.pmid: 15802976
references.citation: Clin Diagn Lab Immunol. 2004 Sep;11(5):930-5
references.pmid: 15358655
references.citation: Clin Diagn Lab Immunol. 2001 Nov;8(6):1171-6
references.pmid: 11687459
references.citation: Clin Diagn Lab Immunol. 2004 Jan;11(1):29-34
references.pmid: 14715541
references.citation: S Afr Med J. 2009 Apr;99(4):243-8
references.pmid: 19588777
references.citation: Bull World Health Organ. 2010 Aug 1;88(8):593-600
references.pmid: 20680124
references.citation: Clin Exp Immunol. 2008 Mar;151(3):432-40
references.pmid: 18190600
references.citation: Genitourin Med. 1996 Feb;72(1):27-31
references.pmid: 8655163
references.citation: PLoS One. 2012;7(10):e47761
references.pmid: 23082211
references.citation: AIDS Res Hum Retroviruses. 2001 Mar 20;17(5):433-41
references.pmid: 11282012
references.citation: Ethiop Med J. 2011 Jul;49(3):187-97
references.pmid: 21991752
references.citation: East Afr Med J. 1996 Oct;73(10):670-4
references.pmid: 8997848
references.citation: Int J Epidemiol. 2011 Apr;40(2):318-26
references.pmid: 20154009
references.citation: Trop Med Int Health. 2012 Jul;17(7):844-53
references.pmid: 22780556
references.citation: Int J Epidemiol. 2008 Oct;37(5):956-62
references.pmid: 17998242
references.citation: Int J STD AIDS. 2010 May;21(5):342-5
references.pmid: 20498104
references.citation: Acta Trop. 2002 Aug;83(2):151-8
references.pmid: 12088856
references.citation: Open AIDS J. 2011;5:74-9
references.pmid: 21892376