The Continuing Burden of Advanced HIV Disease Over 10 Years of Increasing Antiretroviral Therapy Coverage in South Africa.
MetadataShow full item record
JournalClinical Infectious Diseases
AbstractBACKGROUND: Antiretroviral treatment (ART) has been massively scaled up to decrease human immunodeficiency virus (HIV)-related morbidity, mortality, and HIV transmission. However, despite documented increases in ART coverage, morbidity and mortality have remained substantial. This study describes trends in the numbers and characteristics of patients with very advanced HIV disease in the Western Cape, South Africa. METHODS: Annual cross-sectional snapshots of CD4 distributions were described over 10 years, derived from a province-wide cohort of all HIV patients receiving CD4 cell count testing in the public sector. Patients with a first CD4 count <50 cells/µL in each year were characterized with respect to prior CD4 and viral load testing, ART access, and retention in ART care. RESULTS: Patients attending HIV care for the first time initially constituted the largest group of those with CD4 count <50 cells/µL, dropping proportionally over the decade from 60.9% to 26.7%. By contrast, the proportion who were ART experienced increased from 14.3% to 56.7%. In patients with CD4 counts <50 cells/µL in 2016, 51.8% were ART experienced, of whom 76% could be confirmed to be off ART or had recent viremia. More than half who were ART experienced with a CD4 count <50 cells/µL in 2016 were men, compared to approximately one-third of all patients on ART in the same year. CONCLUSIONS: Ongoing HIV-associated morbidity now results largely from treatment-experienced patients not being in continuous care or not being fully virologically suppressed. Innovative interventions to retain ART patients in effective care are an essential priority for the ongoing HIV response.
PublisherOxford University Press
- CD4 cell count recovery among HIV-infected patients with very advanced immunodeficiency commencing antiretroviral treatment in sub-Saharan Africa.
- Authors: Lawn SD, Myer L, Bekker LG, Wood R
- Issue date: 2006 Mar 21
- Linkage to HIV care and antiretroviral therapy in Cape Town, South Africa.
- Authors: Kranzer K, Zeinecker J, Ginsberg P, Orrell C, Kalawe NN, Lawn SD, Bekker LG, Wood R
- Issue date: 2010 Nov 2
- Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study.
- Authors: Cornell M, Schomaker M, Garone DB, Giddy J, Hoffmann CJ, Lessells R, Maskew M, Prozesky H, Wood R, Johnson LF, Egger M, Boulle A, Myer L, International Epidemiologic Databases to Evaluate AIDS Southern Africa Collaboration.
- Issue date: 2012
- Initiating patients on antiretroviral therapy at CD4 cell counts above 200 cells/microl is associated with improved treatment outcomes in South Africa.
- Authors: Fox MP, Sanne IM, Conradie F, Zeinecker J, Orrell C, Ive P, Rassool M, Dehlinger M, van der Horst C, McIntyre J, Wood R
- Issue date: 2010 Aug 24
- Antiretroviral therapy in resource-limited settings 1996 to 2006: patient characteristics, treatment regimens and monitoring in sub-Saharan Africa, Asia and Latin America.
- Authors: ART-LINC Collaboration of International Databases to Evaluate AIDS (IeDEA)., Keiser O, Anastos K, Schechter M, Balestre E, Myer L, Boulle A, Bangsberg D, Touré H, Braitstein P, Sprinz E, Nash D, Hosseinipour M, Dabis F, May M, Brinkhof MW, Egger M
- Issue date: 2008 Jul