title: Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa.
abstract: BACKGROUND
  Short-term morbidity and mortality rates for HIV positive soldiers in the South African National Defence Force (SANDF) would inform decisions about deployment and HIV disease management. Risks were determined according to the latest CD4+ cell count and use of antiretroviral therapy (ART) for HIV positive individuals in the SANDF and their dependents.
  
  
  RESULTS
  A total of 7,114 participants were enrolled and followed for mortality over a median of 4.7 years (IQR: 1.9, 7.1 years). For a planned subset (5,976), progression of disease (POD) and grade 4, potentially life-threatening events were also ascertained. CD4+ count and viral load were measured every 3 to 6 months. Poisson regression was used to compare event rates by latest CD4+ count (<50, 50-99, 100-199, 200-349, 350-499, 500+) with a focus on upper three strata, and to estimate relative risks (RRs) (ART/no ART). Median entry CD4+ was 207 cells/mm3. During follow-up over 70% were prescribed ART. Over follow-up 1,226 participants died; rates ranged from 57.6 (< 50 cells) to 0.8 (500+ cells) per 100 person years (py). Compared to those with latest CD4+ 200-349 (2.2/100 py), death rates were significantly lower (p<0.001), as expected, for those with 350-499 (0.9/100 py) and with 500+ cells (0.8/100 py). The composite outcome of death, POD or grade 4 events occurred in 2,302 participants (4,045 events); rates were similar in higher CD4+ count strata (9.4 for 350-499 and 7.9 for 500+ cells) and lower than those with counts 200-349 cells (13.5) (p<0.001). For those with latest CD4+ 350+ cells, 63% of the composite outcomes (680 of 1,074) were grade 4 events.
  
  
  CONCLUSIONS
  Rates of morbidity and mortality are lowest among those with CD4+ count of 350 or higher and rates do not differ for those with counts of 350-499 versus 500+ cells. Grade 4 events are the predominant morbidity for participants with CD4+ counts of 350+ cells.
authors: South Africa Military Health Services, South African National Defence Forces, Pretoria, South Africa.
authors: Patrick H
authors: PH
authors: Maduna
authors: The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America.
authors: Matt
authors: M
authors: Dolan
authors: Charisma Healthcare Solutions, Pretoria, South Africa.
authors: Lwando
authors: L
authors: Kondlo
authors: South Africa Military Health Services, South African National Defence Forces, Pretoria, South Africa.
authors: Honey
authors: H
authors: Mabuza
authors: Charisma Healthcare Solutions, Pretoria, South Africa.
authors: Judith N
authors: JN
authors: Dlamini
authors: National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.
authors: Mike
authors: M
authors: Polis
authors: South Africa Military Health Services, South African National Defence Forces, Pretoria, South Africa.
authors: Thabo
authors: T
authors: Mnisi
authors: National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.
authors: Susan
authors: S
authors: Orsega
authors: Charisma Healthcare Solutions, Pretoria, South Africa.
authors: Patrick
authors: P
authors: Maja
authors: Charisma Healthcare Solutions, Pretoria, South Africa.
authors: Lotty
authors: L
authors: Ledwaba
authors: Charisma Healthcare Solutions, Pretoria, South Africa.
authors: Thuthukile
authors: T
authors: Molefe
authors: Charisma Healthcare Solutions, Pretoria, South Africa.
authors: Phumelele
authors: P
authors: Sangweni
authors: South Africa Military Health Services, South African National Defence Forces, Pretoria, South Africa.
authors: Lisette
authors: L
authors: Malan
authors: Charisma Healthcare Solutions, Pretoria, South Africa.
authors: Gugu
authors: G
authors: Matchaba
authors: Charisma Healthcare Solutions, Pretoria, South Africa.
authors: Paul
authors: P
authors: Khabo
authors: Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States of America.
authors: Greg
authors: G
authors: Grandits
authors: Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States of America.
authors: James D
authors: JD
authors: Neaton
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data*; D018450:Disease Progression; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality*; D006801:Humans; D008137:Longitudinal Studies; D008889:Military Personnel / Q000706:statistics & numerical data*; D009017:Morbidity / Q000639:trends*; D012044:Regression Analysis; D013019:South Africa / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents