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CD4 counts at HIV diagnosis remain low in Africa
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In sub-Saharan Africa, CD4 counts among HIV patients at presentation and at initiation of ART have not significantly increased over the past decade, suggesting that the goal of early HIV detection has not yet been achieved, according to recent findings published in Clinical Infectious Diseases.
Researchers performed a meta-analysis of published articles pertaining to CD4 count at presentation to care or upon initiation of ART in sub-Saharan Africa from January 2002 to December 2013. They identified 56 articles (n=295,455) addressing CD4 count at presentation and 71 articles (549,702) that investigated CD4 count at initiation of ART.
They found that in 2002, the mean estimated CD4 count was 250 cells/mcL at presentation and 152 cells/mcL at ART initiation. In 2012, the mean estimated CD4 count at presentation was 309 cells/mcL and 140 cells/mcL at the initiation of treatment.
There was not a significant increase seen between 2002 and 2013 in either CD4 count at presentation (5.8 cells/year; 95% CI, –10.7 to 22.4) or CD4 count at initiation of ART (–1.1 cells/year; 95% CI, –8.4 to 6.2). These findings persisted after excluding studies of opportunistic infections or prevention of mother-to-child transmission. In the 14 studies conducted in South Africa, there was an increase in CD4 count at presentation by 39.9 cells/year (95% CI, 9.2-70.7), but there was no change in CD4 count at the commencement of ART.
According to the researchers, these findings suggest that although significant progress has been made in providing ART to millions of HIV patients in sub-Saharan Africa, additional efforts are needed.
“To reduce HIV-related morbidity and mortality at the population level, and to decrease secondary transmission, intensified efforts to increase demand for ART through active testing and facilitated referral should be a priority,” the researchers wrote. “Meanwhile, continued financial investments by multinational partners and the implementation of creative interventions to mitigate delays between presentation to care and ART initiation are needed.”
Disclosure: The researchers report no relevant financial disclosures.
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