CD4 and viral load dynamics in antiretroviral-naïve HIV-infected adults from Soweto, South Africa: a prospective cohort.
BACKGROUND
CD4 count is a proxy for the extent of immune deficiency and declines in CD4 count are a measure of disease progression. Decline in CD4 count is an important component: for estimating benefits of ARV treatment; for individual level counselling on the rapidity of untreated disease progression and prognosis; and can be used in planning demand for health services. Our objective is to report CD4 decline and changes in viral load (VL) in a group of HIV-infected adults enrolled in a randomized trial of preventive treatment for TB in South Africa where clade C infection predominates.


METHODS
HIV-infected, tuberculin skin test positive adults who were not eligible for antiretroviral (ARV) treatment were randomized to a trial of preventive treatment from 2003-2005. VL and CD4 count were assessed at enrollment and CD4 counts repeated at least annually. During follow-up, individuals whose CD4 counts decreased to <200 cells/mm(3) were referred for antiretroviral therapy (ART) and were analytically censored.


RESULTS
1106 ARV naïve adults were enrolled. Their median age was 30 years and male to female ratio was 1:5. Median baseline CD4 count was 490 cells/mm(3) (IQR 351-675). The overall mean decline in CD4 count was 3.2 cells/mm (3) per annum [corrected].Adjusting for age, gender, baseline hemoglobin, smoking and alcohol use had little impact on the estimate of CD4 decline. However, VL at baseline had a major impact on CD4 decline. The percent decline in CD4 count was 13.3% (95% CI 12.0%, 14.7%), 10.6% (95% CI 8.8%, 12.4%), and 13.8% (95% CI 12.1%, 15.5%) per annum for baseline VLs of <10,000 (N = 314), 10,001-100,000 (N = 338), >100,000 (N = 122) copies/ml.


CONCLUSIONS
Our data suggests that six and a half years will elapse for an individual's CD4 count to decline from 750 to 350 cells/mm3 in the absence of ART.
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America; Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research, Johannesburg, South Africa.
Neil A
NA
Martinson
School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
Nikhil
N
Gupte
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Reginah
R
Msandiwa
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America.
Lawrence H
LH
Moulton
School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
Grace L
GL
Barnes
School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
Malathi
M
Ram
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Glenda
G
Gray
School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
Chris
C
Hoffmann
School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
Richard E
RE
Chaisson
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013019:South Africa; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications; D019562:Viral Load; D055815:Young Adult
D044966:Anti-Retroviral Agents