CD4 (+) T cell count decreases by ethnicity among untreated patients with HIV infection in South Africa and Switzerland
May, M.; Wood, R.; Myer, L.; Taffé, P.; Rauch, A.; Battegay, M.; Egger, M.; Battegay, M.; Bernasconi, E.; Böni, J.; Bucher, H.C.; Bürgisser, P.; Calmy, A.; Cattacin, S.; Cavassini, M.; Dubs, R.; Egger, M.; Elzi, L.; Fischer, M.; Flepp, M.; Fontana, A.; Francioli, P.; Furrer, H.; Fux, C.; Gorgievski, M.; Günthard, H.; Hirsch, H.; Hirschel, B.; Hösli, I.; Kahlert, C.; Kaiser, L.; Karrer, U.; Kind, C.; Klimkait, T.; Ledergerber, B.; Martinetti, G.; Martinez, B.; Müller, N.; Nadal, D.; Paccaud
Journal of Infectious Diseases 200(11): 1729-1735
2009
ISSN/ISBN: 1537-6613 PMID: 19848608 DOI: 10.1086/648096Document Number: 208504
Estimates of the decrease in CD4(+) cell counts in untreated patients with human immunodeficiency virus (HIV) infection are important for patient care and public health. We analyzed CD4(+) cell count decreases in the Cape Town AIDS Cohort and the Swiss HIV Cohort Study. We used mixed-effects models and joint models that allowed for the correlation between CD4(+) cell count decreases and survival and stratified analyses by the initial cell count (50-199, 200-349, 350-499, and 500-750 cells/microL). Results are presented as the mean decrease in CD4(+) cell count with 95% confidence intervals (CIs) during the first year after the initial CD4(+) cell count. A total of 784 South African (629 nonwhite) and 2030 Swiss (218 nonwhite) patients with HIV infection contributed 13,388 CD4(+) cell counts. Decreases in CD4(+) cell count were steeper in white patients, patients with higher initial CD4(+) cell counts, and older patients. Decreases ranged from a mean of 38 cells/microL (95% CI, 24-54 cells/microL) in nonwhite patients from the Swiss HIV Cohort Study 15-39 years of age with an initial CD4(+) cell count of 200-349 cells/microL to a mean of 210 cells/microL (95% CI, 143-268 cells/microL) in white patients in the Cape Town AIDS Cohort > or =40 years of age with an initial CD4(+) cell count of 500-750 cells/microL. Among both patients from Switzerland and patients from South Africa, CD4(+) cell count decreases were greater in white patients with HIV infection than they were in nonwhite patients with HIV infection.