Non-uptake of highly active antiretroviral therapy among patients with a CD4 count < 350 cells/μL in the UK.

TitleNon-uptake of highly active antiretroviral therapy among patients with a CD4 count < 350 cells/μL in the UK.
Publication TypeJournal Article
Year of Publication2012
AuthorsKober C, Johnson M, Fisher M, Hill T, Anderson J, Bansi L, Gompels M, Palfreeman A, Dunn D, Gazzard B, Gilson R, Post F, Phillips A, Walsh J, Orkin C, Delpech V, Ainsworth J, Leen C and Sabin C
Corporate AuthorsUK Collaborative HIV Cohort(CHIC) Study
JournalHIV Med
Date Published2012 Jan
KeywordsAdult, Antiretroviral Therapy, Highly Active, Biomarkers, CD4 Lymphocyte Count, Female, Follow-Up Studies, HIV Infections, Humans, Male, Medication Adherence, Proportional Hazards Models, Risk Factors, United Kingdom

OBJECTIVES: Current British HIV Association (BHIVA) guidelines recommend that all patients with a CD4 count <350 cells/μL are offered highly active antiretroviral therapy (HAART). We identified risk factors for delayed initiation of HAART following a CD4 count <350 cells/μL.METHODS: All adults under follow-up in 2008 who had a first confirmed CD4 count <350 cells/μL from 2004 to 2008, who had not initiated treatment and who had >6 months of follow-up were included in the study. Characteristics at the time of the low CD4 cell count and over follow-up were compared to identify factors associated with delayed HAART uptake. Analyses used proportional hazards regression with fixed (sex/risk group, age, ethnicity, AIDS, baseline CD4 cell count and calendar year) and time-updated (frequency of CD4 cell count measurement, proportion of CD4 counts <350 cells/μL, latest CD4 cell count, CD4 percentage and viral load) covariates.RESULTS: Of 4871 patients with a confirmed low CD4 cell count, 436 (8.9%) remained untreated. In multivariable analyses, those starting HAART were older [adjusted relative hazard (aRH)/10  years 1.15], were more likely to be female heterosexual (aRH 1.13), were more likely to have had AIDS (aRH 1.14), had a greater number of CD4 measurements < 350 cells/μL (aRH/additional count 1.18), had a lower CD4 count over follow-up (aRH/50 cells/μL higher 0.57), had a lower CD4 percentage (aRH/5% higher 0.90) and had a higher viral load (aRH/log(10) HIV-1 RNA copies/ml higher 1.06). Injecting drug users (aRH 0.53), women infected with HIV via nonsexual or injecting drug use routes (aRH 0.75) and those of unknown ethnicity (aRH 0.69) were less likely to commence HAART.CONCLUSION: A substantial minority of patients with a CD4 count < 350 cells/μL remain untreated despite its indication.

Alternate JournalHIV Med.
PubMed ID22106827
Grant ListG0900274 / / Medical Research Council / United Kingdom
MC_U122886351 / / Medical Research Council / United Kingdom
G00001999 / / Medical Research Council / United Kingdom
G0600337 / / Medical Research Council / United Kingdom