@article{3107569,
    title = "Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs",
    author = "Anderegg, N. and Panayidou, K. and Abo, Y. and Alejos, B. and Althoff, K.N. and Anastos, K. and Antinori, A. and Balestre, E. and Becquet, R. and Castagna, A. and Castelnuovo, B. and Chêne, G. and Coelho, L. and Collins, I.J. and Costagliola, D. and Crabtree-Ramírez, B. and Dabis, F. and D’Arminio Monforte, A. and Davies, M.-A. and De Wit, S. and Delpech, V. and De La Mata, N.L. and Duda, S. and Freeman, A. and Gange, S.J. and Grabmeier-Pfistershammer, K. and Gunsenheimer-Bartmeyer, B. and Jiamsakul, A. and Kitahata, M.M. and Law, M. and Manzardo, C. and McGowan, C. and Meyer, L. and Moore, R. and Mussini, C. and Nakigoz, G. and Nash, D. and Ng, O.T. and Obel, N. and Pantazis, N. and Poda, A. and Raben, D. and Reiss, P. and Riggen, L. and Sabin, C. and D’Amour Sinayobye, J. and Sönnerborg, A. and Stoeckle, M. and Thorne, C. and Torti, C. and Twizere, C. and Wasmuth, J.-C. and Wittkop, L. and Wools-Kaloustian, K. and Yotebieng, M. and Kirk, O. and Egger, M. and The IeDEA and COHERE Cohort Collaborations",
    journal = "Clinical Infectious Diseases",
    year = "2018",
    volume = "66",
    number = "6",
    pages = "893-903",
    publisher = "Oxford University Press",
    issn = "1058-4838, 1537-6591",
    doi = "10.1093/cid/cix915",
    keywords = "anti human immunodeficiency virus agent, adult;  Africa south of the Sahara;  antiretroviral therapy;  Article;  Asia;  CD4 lymphocyte count;  female;  high income country;  human;  Human immunodeficiency virus infected patient;  Human immunodeficiency virus infection;  lowest income group;  major clinical study;  male;  middle income group;  North America;  priority journal;  sex difference;  trend study;  Western Hemisphere;  CD4 lymphocyte count;  cohort analysis;  disease exacerbation;  Europe;  global health;  highly active antiretroviral therapy;  Human immunodeficiency virus infection;  income;  international cooperation;  middle aged;  poverty;  practice guideline;  World Health Organization, Adult;  Anti-HIV Agents;  Antiretroviral Therapy, Highly Active;  CD4 Lymphocyte Count;  Cohort Studies;  Disease Progression;  Europe;  Female;  Global Health;  HIV Infections;  Humans;  Income;  International Cooperation;  Male;  Middle Aged;  Poverty;  Practice Guidelines as Topic;  World Health Organization",
    abstract = "Background. Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodefciency virus (HIV). We describe the temporal trends in CD4 cell counts at the start of cART in adults from low-income, lower-middle-income, upper-middle-income, and high-income countries (LICs, LMICs, UMICs, and HICs, respectively). Methods. We included HIV-infected individuals aged =16 years who started cART between 2002 and 2015 in a clinic participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) or the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Missing CD4 cell counts at the start of cART were estimated through multiple imputation. Weighted mixed-e?ect models were used to smooth trends in median CD4 cell counts. Results. A total of 951 855 adults from 16 LICs, 11 LMICs, 9 UMICs, and 19 HICs were included. Overall, the modeled median CD4 cell count at the start of cART increased from 2002 to 2015, from 78/μL (95% confdence interval, 58-104/μL) to 287/μL (250-328/μL) in LICs, from 99/μL (71-140/μL) to 234/μL (192-285/μL) in LMICs, from 71/μL (49-104/μL) to 311/μL (255-379/μL) in UMICs, and from 161/μL (143-181/μL) to 327/μL (286-372/μL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed. Conclusions. Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional e?orts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART. © 2017 The Author(s)."
}