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|Title: ||Predictors of CD4 cell count response to first-line combination antiretroviral treatment among HIV-positive adult patients from the Asia-Pacific region|
|Authors: ||De La Mata, Nicole|
|Issue Date: ||13-Sep-2016|
|Abstract: ||The introduction of combination antiretroviral treatment (ART) has had substantial impact on the human immunodeficiency virus (HIV) epidemic [1, 2]. Patients responding to ART have reduced HIV viral replication and lower rates of HIV-associated morbidity, mortality and AIDS-related events [3-5]. Recommendations on when to initiate ART is largely based upon the CD4 T lymphocyte cell count [6-10]. The CD4 T lymphocyte cell is generally regarded as an indicator of immune deficiency and used as a prognostic marker of HIV disease progression [11-13].
Early World Health Organisation (WHO) guidelines recommended ART initiation when patients were at an advanced stage of HIV or in asymptomatic stages of HIV with a CD4 cell count below 200cells/μL . However, recent research has suggested that initiating ART at higher CD4 cell count levels has greater benefits in preventing further disease progression, further HIV transmission and reduced occurrence of opportunistic infections [14-17]. Although ideal, earlier ART initiation has been difficult to implement, particularly in low-income or resource-limited countries, as it requires patients to access health care facilities to receive HIV testing and diagnosis at early stages of disease progression [18, 19].
The Asia Pacific region retains a heavy burden of the HIV epidemic, with close to 5 million people living with HIV in 2013 [20, 21]. Despite an increasing push towards earlier initiation of ART, barriers to receiving care have contributed to the inability of many HIV-positive patients, within the Asia-Pacific region, to be diagnosed and initiate ART at higher CD4 cell count levels [22, 23]. In 2012, UNAIDS estimates for the Asia-Pacific region indicated that the number of people accessing ART has increased yet, the treatment coverage rate remains lower than the global average at 51% and a majority of people living with HIV are not diagnosed . Patients presenting with CD4 cell counts <200 cells/μL require longer periods of time to fully restore CD4 cell count levels which increases there susceptibility to treatment failure and death . Other factors, such as previous exposure to mono/duo therapy and older age, are also known to hinder CD4 restoration [24, 25].
The study objective is to examine the CD4 cell count response to first-line ART among HIV-positive patients from the TREAT Asia HIV Observational database low intensity transfer (TAHOD-LITE). Factors associated with mean CD4 cell count at 12 months will also be evaluated. Study findings will be useful for guiding decision making in future programs addressing the HIV-epidemic in the Asia-Pacific region.|
|Description: ||This project utilized observational data on HIV-positive patients that was previously collected for the TREAT Asia HIV Observational Databases Low Intensity Transfer (TAHOD-LITE). The study objective was to evaluate the predictors associated with CD4 cell count changes from combination antiretroviral treatment initiation for those who had sought care in 2010-13. The intention was to determine whether certain treatment related and demographic factors could contribute to improved CD4 cell count restoration.|
|Type of Work: ||Other|
|Type of Publication: ||Pre-print|
|Appears in Collections:||Master of Biostatistics Workplace Project Portfolios|
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