Mashiri Chiedza Elvina, Batidzirai Jesca Mercy, Chifurira Retius, Chinhamu Knowledge
Department of Applied Mathematics and Statistics, Midlands State University, Gweru 9055, Zimbabwe.
School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Howard College Campus, Durban 4041, South Africa.
Trop Med Infect Dis. 2024 Jul 10;9(7):154. doi: 10.3390/tropicalmed9070154.
CD4 count recovery is the main goal for an HIV patient who initiated ART. Early ART initiation in HIV patients can help restore immune function more effectively, even when they have reached an advanced stage. Some patients may respond positively to ART and attain CD4 count recovery. Meanwhile, other patients failing to recover their CD4 count due to non-adherence, treatment resistance and virological failure might lead to HIV-related complications and death. The purpose of this study was to find the determinants of death in patients who failed to recover their CD4 count after initiating antiretroviral therapy. The data used in this study was obtained from KwaZulu-Natal, South Africa, where 2528 HIV-infected patients with a baseline CD4 count of <200 cells/mm were initiated on ART. We used a Fine-Gray sub-distribution hazard and cumulative incidence function to estimate potential confounding factors of death, where CD4 count recovery was a competing event for failure due to death. Patients who had no tuberculosis were 1.33 times at risk of dying before attaining CD4 count recovery [aSHR 1.33; 95% CI (0.96-1.85)] compared to those who had tuberculosis. Rural patients had a higher risk of not recovering and leading to death [aSHR 1.97; 95% CI (1.57-2.47)] than those from urban areas. The patient's tuberculosis status, viral load, regimen, baseline CD4 count, and location were significant contributors to death before CD4 count recovery. Intervention programs targeting HIV testing in rural areas for early ART initiation and promoting treatment adherence are recommended.
CD4细胞计数恢复是开始接受抗逆转录病毒治疗（ART）的HIV患者的主要目标。HIV患者早期开始ART治疗可更有效地帮助恢复免疫功能，即使他们已处于疾病晚期。一些患者可能对ART有积极反应并实现CD4细胞计数恢复。与此同时，其他因不依从、治疗耐药和病毒学失败而未能恢复CD4细胞计数的患者可能会导致HIV相关并发症和死亡。本研究的目的是找出在开始抗逆转录病毒治疗后未能恢复CD4细胞计数的患者的死亡决定因素。本研究使用的数据来自南非夸祖鲁-纳塔尔省，该地区有2528名基线CD4细胞计数<200个细胞/mm³的HIV感染患者开始接受ART治疗。我们使用Fine-Gray亚分布风险和累积发病率函数来估计死亡的潜在混杂因素，其中CD4细胞计数恢复是因死亡导致失败的竞争事件。与患有结核病的患者相比，未患结核病的患者在实现CD4细胞计数恢复之前死亡的风险高1.33倍[调整后标准化风险比（aSHR）1.33；95%置信区间（0.96 - 1.85）]。农村患者比城市患者有更高的未恢复并导致死亡的风险[aSHR 1.97；95%置信区间（1.57 - 2.47）]。患者的结核病状态、病毒载量、治疗方案、基线CD4细胞计数和地理位置是CD4细胞计数恢复前死亡的重要因素。建议开展针对农村地区HIV检测以早期开始ART治疗并促进治疗依从性的干预项目。
