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Impact of age and sex on CD4+ cell count trajectories following treatment initiation : an analysis of the Tanzanian HIV treatment database

dc.contributor.authorMeans, Arianna R.en_ZA
dc.contributor.authorRisher, Kathryn A.en_ZA
dc.contributor.authorUjeneza, Eva L.en_ZA
dc.contributor.authorMaposa, Innocenten_ZA
dc.contributor.authorNondi, Josephen_ZA
dc.contributor.authorBellan, Steven E.en_ZA
dc.date.accessioned2017-10-11T13:06:38Z
dc.date.available2017-10-11T13:06:38Z
dc.date.issued2016
dc.identifier.citationMeans, A. R., et al. 2016. Impact of age and sex on CD4+ cell count trajectories following treatment initiation : an analysis of the Tanzanian HIV treatment database. PLoS ONE, 11(10):e0164148, doi:10.1371/journal.pone.0164148
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0164148
dc.identifier.urihttp://hdl.handle.net/10019.1/102308
dc.descriptionCITATION: Means, A. R., et al. 2016. Impact of age and sex on CD4+ cell count trajectories following treatment initiation : an analysis of the Tanzanian HIV treatment database. PLoS ONE, 11(10):e0164148, doi:10.1371/journal.pone.0164148.
dc.descriptionThe original publication is available at http://journals.plos.org/plosone
dc.description.abstractObjective: New guidelines recommend that all HIV-infected individuals initiate antiretroviral treatment (ART) immediately following diagnosis. This study describes how immune reconstitution varies by gender and age to help identify poorly reconstituting subgroups and inform targeted testing initiatives. Design Longitudinal data from the outpatient monitoring system of the National AIDS Control Program in Tanzania. Methods: An asymptotic nonlinear mixed effects model was fit to post-treatment CD4+ cell count trajectories, allowing for fixed effects of age and sex, and an age by sex interaction. Results: Across 220,544 clinic visits from 32,069 HIV-infected patients, age- and sex-specific average CD4+ cell count at ART initiation ranged from 83–136 cells/mm3, long term asymptotic CD4+ cell count ranged from 301–389 cells/mm3, and time to half of maximal CD4+ reconstitution ranged from 3.57–5.68 months. CD4+ cell count at ART initiation and asymptotic CD4+ cell count were 1.28 (95% CI: 1.18–1.40) and 1.25 (95% CI: 1.20–1.31) times higher, respectively, for females compared to males in the youngest age group (19–29 years). Older patients started treatment at higher CD4+ counts but experienced slower CD4+ recovery than younger adults. Treatment initiation at greater CD4+ cell counts was correlated with greater asymptotic CD4+ cell counts within all sex and age groups. Conclusion: Older adults should initiate care early in disease progression because total immune reconstitution potential and rate of reconstitution appears to decrease with age. Targeted HIV testing and care linkage remains crucial for patient populations who tend to initiate treatment at lower CD4+ cell counts, including males and younger adults.en_ZA
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164148
dc.format.extent13 pages
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Science
dc.subjectHIV infections -- Treatment -- Tanzaniaen_ZA
dc.subjectAntiretroviral therapy -- Effectivenessen_ZA
dc.subjectOlder HIV-positive personsen_ZA
dc.subjectHIV-positive womenen_ZA
dc.subjectHIV-positive menen_ZA
dc.subjectHIV-positive youthe
dc.titleImpact of age and sex on CD4+ cell count trajectories following treatment initiation : an analysis of the Tanzanian HIV treatment databaseen_ZA
dc.typeArticleen_ZA
dc.description.versionPublisher's version
dc.rights.holderAuthors retain copyright


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