Trends in CD4 Count at Presentation to Care and Treatment Initiation in Sub-Saharan Africa, 2002-2013: A Meta-analysis
Trends in CD4 Count at Presentation to Care and Treatment Initiation in Sub-Saharan Africa, 2002-2013: A Meta-analysis
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DOI：
10.1093/cid/ciu1137
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发表时间：
2015-04-01
影响因子：
11.8
通讯作者：
Tsai, Alexander C.
中科院分区：
文献类型：
--
作者：
Siedner, Mark J.;Ng, Courtney K.;Tsai, Alexander C.
背景资料。人类免疫缺陷病毒(HIV)的抗逆转录病毒疗法(ART)在人群和个人层面的益处都取决于早期诊断和开始治疗。我们评估了撒哈拉以南非洲地区在介绍到护理和ART启动时疾病状况的趋势。我们在PubMed上搜索2002年1月至2013年12月发表的研究，这些研究报告了撒哈拉以南非洲成年人在陈述或接受ART治疗时的CD4细胞计数。我们提取了研究样本量、年份(S)和平均CD_4计数。在每一年的观察期内，使用随机效应的Meta回归模型来获得合并估计。我们确定了56篇报告陈述时的CD4计数的文章(N=295 455)和71篇报告ART开始时的CD4计数的文章(N=549 702)。2002年，平均估计的CD_4细胞数在陈述时为251个细胞/亩L，在ART开始时为152个/亩L。在2002-2013年间，无论是初诊时的CD4计数(贝塔=5.8个/年；95%可信区间[CI]，-10.7至22.4个/年)，还是开始抗逆转录病毒治疗时的CD4计数(贝塔=-1.1个/年；95%可信区间，-8.4至6.2个/年)都没有显著增加。排除对机会性感染或预防母婴传播的研究并没有改变我们的发现。在南非(N=14)进行的研究中，初诊时的CD4计数增加了39.9个/年(95%可信区间为9.2-70.2个/年；P=0.02)，但开始抗逆转录病毒治疗时的CD4计数没有变化。在过去十年中，撒哈拉以南非洲地区在介绍护理和接受抗逆转录病毒治疗时的CD4计数没有增加。介绍、诊断和与艾滋病毒护理联系的障碍仍然是需要注意的主要挑战，需要注意优化抗逆转录病毒疗法的人口层面的好处。
Background. Both population- and individual-level benefits of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) are contingent on early diagnosis and initiation of therapy. We estimated trends in disease status at presentation to care and at ART initiation in sub-Saharan Africa.Methods. We searched PubMed for studies published January 2002-December 2013 that reported CD4 cell count at presentation or ART initiation among adults in sub-Saharan Africa. We abstracted study sample size, year(s), and mean CD4 count. A random-effects meta-regression model was used to obtain pooled estimates during each year of the observation period.Results. We identified 56 articles reporting CD4 count at presentation (N = 295 455) and 71 articles reporting CD4 count at ART initiation (N = 549 702). The mean estimated CD4 count in 2002 was 251 cells/mu L at presentation and 152 cells/mu L at ART initiation. During 2002-2013, neither CD4 count at presentation (beta = 5.8 cells/year; 95% confidence interval [CI], -10.7 to 22.4 cells/year), nor CD4 count at ART initiation (beta = -1.1 cells/year; 95% CI, -8.4 to 6.2 cells/year) increased significantly. Excluding studies of opportunistic infections or prevention of mother-to-child transmission did not alter our findings. Among studies conducted in South Africa (N = 14), CD4 count at presentation increased by 39.9 cells/year (95% CI, 9.2-70.2 cells/year; P = .02), but CD4 count at ART initiation did not change.Conclusions. CD4 counts at presentation to care and at ART initiation in sub-Saharan Africa have not increased over the past decade. Barriers to presentation, diagnosis, and linkage to HIV care remain major challenges that require attention to optimize population-level benefits of ART.