title: Time to eligibility for antiretroviral therapy in adults with CD4 cell count > 500 cells/μL in rural KwaZulu-Natal, South Africa.
abstract: OBJECTIVE
  Understanding of progression to antiretroviral therapy (ART) eligibility and associated factors remains limited. The objectives of this analysis were to determine the time to ART eligibility and to explore factors associated with disease progression in adults with early HIV infection.
  
  
  METHODS
  HIV-infected adults (≥ 18 years old) with CD4 cell count > 500 cells/μl were enrolled in the study at three primary health care clinics, and a sociodemographic, behavioural and partnership-level questionnaire was administered. Participants were followed 6-monthly and ART eligibility was determined using a CD4 cell count threshold of 350 cells/μl. Kaplan - Meier and Cox proportional hazard regression modelling were used in the analysis.
  
  
  RESULTS
  A total of 206 adults contributed 381 years of follow-up; 79 (38%) reached the ART eligibility threshold. Median time to ART eligibility was shorter for male patients (12.0 months) than for female patients (33.9 months). Male sex [adjusted hazard ratio (aHR) 3.13; 95% confidence interval (CI) 1.82-5.39], residing in a household with food shortage in the previous year (aHR 1.58; 95% CI 0.99-2.54), and taking nutritional supplements in the first 6 months after enrolment (aHR 2.06; 95% CI 1.11-3.83) were associated with shorter time to ART eligibility. Compared with reference CD4 cell count ≤  559 cells/μl, higher CD4 cell count was associated with longer time to ART eligibility [aHR 0.46 (95% CI 0.25-0.83) for CD4 cell count 560-632 cells/μl; aHR 0.30 (95% CI 0.16-0.57) for CD4 cell count 633-768 cells/μl; and aHR 0.17 (95% CI 0.08-0.38) for CD4 cell count > 768 cells/μl].
  
  
  CONCLUSIONS
  Over one in three adults with CD4 cell count > 500 cells/μl became eligible for ART at a CD4 cell count threshold of 350 cells/μl over a median of 2 years. The shorter time to ART eligibility in male patients suggests a possible need for sex-specific pre-ART care and monitoring strategies.
authors.affiliation: Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK.|Department of Social Statistics and Demography, University of Southampton, Southampton, UK.|Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: McGrath
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.|Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lessells
authors.affiliation: Department of Social Statistics and Demography, University of Southampton, Southampton, UK.|Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.|Academic Unit of Human Development and Health, University of Southampton, Southampton, UK.
authors.forename: M L
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000706:statistics & numerical data; D018579:Patient Selection; D016016:Proportional Hazards Models; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D013019:South Africa; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; antiretroviral therapy; sub-Saharan Africa