PMID- 32257156
OWN - NLM
STAT- MEDLINE
DCOM- 20200415
LR  - 20220413
IS  - 2047-2986 (Electronic)
IS  - 2047-2978 (Print)
IS  - 2047-2978 (Linking)
VI  - 10
IP  - 1
DP  - 2020 Jun
TI  - How varying CD4 criteria for treatment initiation was associated with mortality 
      of HIV-patients? A retrospective analysis of electronic health records from 
      Andhra Pradesh, India.
PG  - 010408
LID - 10.7189/jogh.10.010408 [doi]
LID - 010408
AB  - BACKGROUND: HIV treatment and care services were scaled up in 2007 in India with 
      objective to increase HIV-care coverage. CD4 count based criteria was mainly used 
      for treatment initiation with increasing threshold in later years. Therefore, 
      this paper aimed to evaluate the survival by varying CD4 criteria for 
      antiretroviral treatment (ART) initiation among of HIV-positive patients, and 
      independent factors associated with the mortality. METHODS: This retrospective 
      cohort study included 127 949 HIV-positive patients aged >/=15 years, who initiated 
      ART between 2007 and 2013 in Andhra Pradesh state, India. The patient's 
      demographic and clinical characteristics were extracted from the patient's health 
      records from electronic Computerized Management Information System Software 
      (CMIS). Incidence of mortality/100 person-years was calculated for CD4 and 
      treatment initiation categories. Kaplan-Meier and multivariable Cox-regression 
      analyses were used to explore the association. RESULTS: Median CD4 count was 172 
      (inter-quartile range (IQR) = 102-240) at the time of treatment initiation, and 
      19.3% of them had </= 100 CD4 count. Incidence of mortality for the period 2007-08 
      (CD4 </= 200 cells/mm(3)) was 8.5/100 person-years compared to 6.4/100 person-years 
      at risk for the period 2012 onwards (CD4 </= 350 cells/mm(3)). Earlier thresholds 
      for treatment initiation showed higher risk of mortality (2007-08 (CD4 </= 200 
      cells/mm(3)), adjusted hazard ratio (HR): 1.86, 95% confidence interval (CI): 
      1.68-2.07; 2009-11 (CD4 </= 250 cells/mm(3)), HR = 1.67, 95% CI = 1.51-1.85) 
      compared to 2012 onwards (CD4 </= 350 cells/mm(3)) criteria for treatment 
      initiation. CONCLUSIONS: Increasing CD4 threshold for treatment initiation over 
      time was independently associated with lower risk of mortality. More efforts are 
      required to detect and treat early, monitoring of follow-ups, promote health 
      education to improve ART adherence, and provide supportive environment that 
      encourages HIV-infected patients to disclose their HIV status in confidence.
CI  - Copyright (c) 2020 by the Journal of Global Health. All rights reserved.
FAU - Bajpai, Ram
AU  - Bajpai R
AD  - School of Primary Community and Social Care, Keele University, 
      Newcastle-Under-Lyme, Staffordshire, UK.
AD  - National Institute of Medical Statistics, Indian Council of Medical Research, New 
      Delhi, India.
FAU - Chaturvedi, Himanshu K
AU  - Chaturvedi HK
AD  - National Institute of Medical Statistics, Indian Council of Medical Research, New 
      Delhi, India.
FAU - Car, Josip
AU  - Car J
AD  - Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang 
      Technological University, Singapore.
AD  - Global eHealth Unit, Department of Primary Care and Public Health, School of 
      Public Health, Imperial College London, London, UK.
LA  - eng
PT  - Journal Article
PL  - Scotland
TA  - J Glob Health
JT  - Journal of global health
JID - 101578780
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Anti-HIV Agents/*therapeutic use
MH  - CD4 Lymphocyte Count
MH  - *Electronic Health Records
MH  - Female
MH  - HIV Infections/*drug therapy/mortality/virology
MH  - Hospital Mortality
MH  - Humans
MH  - Incidence
MH  - India
MH  - Male
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Retrospective Studies
PMC - PMC7125424
COIS- Conflicts of interest: The authors completed the ICMJE Unified Competing Interest 
      form (available upon request from the corresponding author), and declare no 
      conflicts of interest.
EDAT- 2020/04/08 06:00
MHDA- 2020/04/16 06:00
PMCR- 2020/03/30
CRDT- 2020/04/08 06:00
PHST- 2020/04/08 06:00 [entrez]
PHST- 2020/04/08 06:00 [pubmed]
PHST- 2020/04/16 06:00 [medline]
PHST- 2020/03/30 00:00 [pmc-release]
AID - jogh-10-010408 [pii]
AID - 10.7189/jogh.10.010408 [doi]
PST - ppublish
SO  - J Glob Health. 2020 Jun;10(1):010408. doi: 10.7189/jogh.10.010408.