Suboptimal immune response among adults on first-line antiretroviral therapy within the IeDEA East Africa cohort

Authors: Nakanjako D, Kiragga A, Yiannoutsos C, Kambugu A, Easterbrook P, on behalf of IeDEA- EA

Abstract # TUPDB0105 IAS 30th June-3 July 2013, Kuala Lumpar Malaysia

Definitions of suboptimal CD4 recovery

i) magnitude criteria: CD4 increase <50 cells at

6 months, <100 cells at 12 months and <200

cells at 24 months

ii) CD4 threshold criteria: absolute CD4 count

<200 cells/UL at 6, 12 and 24 months

iii) Population-specific criteria: Lowest quartile

CD4 count increases in the HAART cohort

Tuboi SH, JAIDS 2007, Lawn SD, BMC ID, 2007, Lawn SD, AIDS 2001

Statistical methods

• Used Kaplan Meier survival analysis

to analyse time to normalization

(CD4 > 500 cells)

• Considered competing risks of death and loss to follow-up

Overall 83,926 adults initiated antiretroviral therapy at 7 sites in East Africa

6 months

23029 (27%) In-care with a CD4 measurement

24 months 10232 (12%)In-care with aCD4 measurement

CD4 recovery

Suboptimal Optimal Suboptimal Optimal

5528 (25%) 17501 (75%)

5183 (51%) 5049 (49%)

OI after suboptimal response

996 (18%) 12498 (14%)

612 (12%) 463 (9%)

P<0.0001 P=0.0001

Incidence of normalisation with competing risks of death and Loss to follow up

Years from ART initiation

Cumulative incidence of achieving CD4≥ 350 cells/UL

Cumulative incidence ofachieving CD4≥500 cells/UL

1 26.3% 15.9%

2 41.5% 22.0%

3 49.9% 27.3%

4 54.7% 33.2%

5 57.7% 37.7%

6 59.8% 40.8%

7 26.6% 34.4%

8 61.9% 45.2%

9 8.6% 36.4%

10 63.0% 49.8%

Policy issues• Need to increase access to routine CD4 in routine

HIV care & treatment programs

• Routine viral loads for poor CD4 responders to identify suboptimal responder population

• Increase adherence and retention in care to allow quality follow up

• Interventions to optimise immune recovery among suboptimal responders despite viral suppression

Acknowledgement