Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa.
BACKGROUND:Short-term morbidity and mortality rates for HIV positive soldiers in the South African National Defence Force (SANDF) would inform decisions about deployment and HIV disease management. Risks were determined according to the latest CD4+ cell count and use of antiretroviral therapy (ART)...
Main Authors: | , , , , , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Public Library of Science (PLoS)
2015-01-01
|
Series: | PLoS ONE |
Online Access: | http://europepmc.org/articles/PMC4391777?pdf=render |
id |
doaj-65eb1ab0cd1a474698ae730ff7216e58 |
---|---|
record_format |
Article |
spelling |
doaj-65eb1ab0cd1a474698ae730ff7216e582020-11-24T21:11:03ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-01104e012184310.1371/journal.pone.0121843Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa.Patrick H MadunaMatt DolanLwando KondloHoney MabuzaJudith N DlaminiMike PolisThabo MnisiSusan OrsegaPatrick MajaLotty LedwabaThuthukile MolefePhumelele SangweniLisette MalanGugu MatchabaPaul KhaboGreg GranditsJames D NeatonBACKGROUND:Short-term morbidity and mortality rates for HIV positive soldiers in the South African National Defence Force (SANDF) would inform decisions about deployment and HIV disease management. Risks were determined according to the latest CD4+ cell count and use of antiretroviral therapy (ART) for HIV positive individuals in the SANDF and their dependents. METHODS AND FINDINGS:A total of 7,114 participants were enrolled and followed for mortality over a median of 4.7 years (IQR: 1.9, 7.1 years). For a planned subset (5,976), progression of disease (POD) and grade 4, potentially life-threatening events were also ascertained. CD4+ count and viral load were measured every 3 to 6 months. Poisson regression was used to compare event rates by latest CD4+ count (<50, 50-99, 100-199, 200-349, 350-499, 500+) with a focus on upper three strata, and to estimate relative risks (RRs) (ART/no ART). Median entry CD4+ was 207 cells/mm3. During follow-up over 70% were prescribed ART. Over follow-up 1,226 participants died; rates ranged from 57.6 (< 50 cells) to 0.8 (500+ cells) per 100 person years (py). Compared to those with latest CD4+ 200-349 (2.2/100 py), death rates were significantly lower (p<0.001), as expected, for those with 350-499 (0.9/100 py) and with 500+ cells (0.8/100 py). The composite outcome of death, POD or grade 4 events occurred in 2,302 participants (4,045 events); rates were similar in higher CD4+ count strata (9.4 for 350-499 and 7.9 for 500+ cells) and lower than those with counts 200-349 cells (13.5) (p<0.001). For those with latest CD4+ 350+ cells, 63% of the composite outcomes (680 of 1,074) were grade 4 events. CONCLUSION:Rates of morbidity and mortality are lowest among those with CD4+ count of 350 or higher and rates do not differ for those with counts of 350-499 versus 500+ cells. Grade 4 events are the predominant morbidity for participants with CD4+ counts of 350+ cells.http://europepmc.org/articles/PMC4391777?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Patrick H Maduna Matt Dolan Lwando Kondlo Honey Mabuza Judith N Dlamini Mike Polis Thabo Mnisi Susan Orsega Patrick Maja Lotty Ledwaba Thuthukile Molefe Phumelele Sangweni Lisette Malan Gugu Matchaba Paul Khabo Greg Grandits James D Neaton |
spellingShingle |
Patrick H Maduna Matt Dolan Lwando Kondlo Honey Mabuza Judith N Dlamini Mike Polis Thabo Mnisi Susan Orsega Patrick Maja Lotty Ledwaba Thuthukile Molefe Phumelele Sangweni Lisette Malan Gugu Matchaba Paul Khabo Greg Grandits James D Neaton Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa. PLoS ONE |
author_facet |
Patrick H Maduna Matt Dolan Lwando Kondlo Honey Mabuza Judith N Dlamini Mike Polis Thabo Mnisi Susan Orsega Patrick Maja Lotty Ledwaba Thuthukile Molefe Phumelele Sangweni Lisette Malan Gugu Matchaba Paul Khabo Greg Grandits James D Neaton |
author_sort |
Patrick H Maduna |
title |
Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa. |
title_short |
Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa. |
title_full |
Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa. |
title_fullStr |
Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa. |
title_full_unstemmed |
Morbidity and mortality according to latest CD4+ cell count among HIV positive individuals in South Africa who enrolled in project Phidisa. |
title_sort |
morbidity and mortality according to latest cd4+ cell count among hiv positive individuals in south africa who enrolled in project phidisa. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2015-01-01 |
description |
BACKGROUND:Short-term morbidity and mortality rates for HIV positive soldiers in the South African National Defence Force (SANDF) would inform decisions about deployment and HIV disease management. Risks were determined according to the latest CD4+ cell count and use of antiretroviral therapy (ART) for HIV positive individuals in the SANDF and their dependents. METHODS AND FINDINGS:A total of 7,114 participants were enrolled and followed for mortality over a median of 4.7 years (IQR: 1.9, 7.1 years). For a planned subset (5,976), progression of disease (POD) and grade 4, potentially life-threatening events were also ascertained. CD4+ count and viral load were measured every 3 to 6 months. Poisson regression was used to compare event rates by latest CD4+ count (<50, 50-99, 100-199, 200-349, 350-499, 500+) with a focus on upper three strata, and to estimate relative risks (RRs) (ART/no ART). Median entry CD4+ was 207 cells/mm3. During follow-up over 70% were prescribed ART. Over follow-up 1,226 participants died; rates ranged from 57.6 (< 50 cells) to 0.8 (500+ cells) per 100 person years (py). Compared to those with latest CD4+ 200-349 (2.2/100 py), death rates were significantly lower (p<0.001), as expected, for those with 350-499 (0.9/100 py) and with 500+ cells (0.8/100 py). The composite outcome of death, POD or grade 4 events occurred in 2,302 participants (4,045 events); rates were similar in higher CD4+ count strata (9.4 for 350-499 and 7.9 for 500+ cells) and lower than those with counts 200-349 cells (13.5) (p<0.001). For those with latest CD4+ 350+ cells, 63% of the composite outcomes (680 of 1,074) were grade 4 events. CONCLUSION:Rates of morbidity and mortality are lowest among those with CD4+ count of 350 or higher and rates do not differ for those with counts of 350-499 versus 500+ cells. Grade 4 events are the predominant morbidity for participants with CD4+ counts of 350+ cells. |
url |
http://europepmc.org/articles/PMC4391777?pdf=render |
work_keys_str_mv |
AT patrickhmaduna morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT mattdolan morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT lwandokondlo morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT honeymabuza morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT judithndlamini morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT mikepolis morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT thabomnisi morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT susanorsega morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT patrickmaja morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT lottyledwaba morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT thuthukilemolefe morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT phumelelesangweni morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT lisettemalan morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT gugumatchaba morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT paulkhabo morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT greggrandits morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa AT jamesdneaton morbidityandmortalityaccordingtolatestcd4cellcountamonghivpositiveindividualsinsouthafricawhoenrolledinprojectphidisa |
_version_ |
1716754695375028224 |