Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
HIV Med. 2021 Jan;22(1):1-10. doi: 10.1111/hiv.12951. Epub 2020 Sep 2.
National guidelines in Botswana recommend baseline CD4 count measurement and both CD4 and HIV viral load (VL) monitoring post-antiretroviral therapy (ART) initiation. We evaluated the utility of CD4 count measurement in Botswana in the era of universal ART.
CD4 and VL data were analysed for HIV-infected adults undergoing CD4 count measurement in 2015-2017 at the Botswana Harvard HIV-Reference Laboratory. We determined (1) the proportion of individuals with advanced HIV disease (CD4 count < 200 cells/µL) at initial CD4 assessment, (2) the proportion with an initial CD4 count ≥ 200 cells/µL experiencing a subsequent decline in CD4 count to < 200 cells/µL, and (3) the proportion of these immunologically failing individuals who had virological failure. Logistic regression modelling examined factors associated with advanced HIV disease. CD4 count trajectories were assessed using locally weighted scatterplot smoothing (LOWESS) regression.
Twenty-five per cent (3571/14 423) of individuals with an initial CD4 assessment during the study period had advanced HIV disease at baseline. Older age [≥ 35 years; adjusted odds ratio (aOR) 1.9; 95% confidence interval (CI) 1.8-2.1] and male sex were associated with advanced HIV disease. Fifty per cent (7163/14 423) of individuals had at least two CD4 counts during the study period. Of those with an initial CD4 count ≥ 200 cells/µL, 4% (180/5061) experienced a decline in CD4 count to < 200 cells/µL; the majority of CD4 count declines were in virologically suppressed individuals and transient.
One-quarter of HIV-positive individuals in Botswana still present with advanced HIV disease, highlighting the importance of baseline CD4 count measurement to identify this at-risk population. Few with a baseline CD4 count ≥ 200 cells/µL experienced a drop below 200 cells/µL, suggesting limited utility for ongoing CD4 monitoring.
博茨瓦纳国家指南建议在开始抗逆转录病毒治疗（ART）后进行基线 CD4 计数测量以及 CD4 和 HIV 病毒载量（VL）监测。我们评估了在普遍开展 ART 的时代，博茨瓦纳进行 CD4 计数测量的效用。
对 2015 年至 2017 年在博茨瓦纳哈佛 HIV 参考实验室进行 CD4 计数测量的 HIV 感染成年人的 CD4 和 VL 数据进行了分析。我们确定了：（1）初始 CD4 评估时患有晚期 HIV 疾病（CD4 计数<200 个细胞/µL）的个体比例；（2）初始 CD4 计数≥200 个细胞/µL 的个体中随后出现 CD4 计数降至<200 个细胞/µL 的比例；以及（3）这些免疫功能失败的个体中发生病毒学失败的比例。逻辑回归模型分析了与晚期 HIV 疾病相关的因素。使用局部加权散点图平滑（LOWESS）回归评估 CD4 计数轨迹。
在研究期间进行初始 CD4 评估的 25%（3571/14423）的个体在基线时患有晚期 HIV 疾病。年龄较大（≥35 岁；调整后的优势比（aOR）1.9；95%置信区间（CI）1.8-2.1）和男性与晚期 HIV 疾病相关。在研究期间，50%（7163/14423）的个体至少有两次 CD4 计数。在初始 CD4 计数≥200 个细胞/µL 的个体中，有 4%（180/5061）的个体 CD4 计数下降至<200 个细胞/µL；大多数 CD4 计数下降发生在病毒学抑制的个体中，并且是短暂的。
博茨瓦纳四分之一的 HIV 阳性个体仍患有晚期 HIV 疾病，这突显了基线 CD4 计数测量的重要性，以识别这一高危人群。很少有基线 CD4 计数≥200 个细胞/µL 的个体的 CD4 计数下降到 200 个细胞/µL 以下，这表明持续的 CD4 监测的实用性有限。
