CD4+ Response and Subsequent Risk of Death Among Patients on Antiretroviral Therapy in Lusaka, Zambia

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Abstract
Introduction: Where virologic monitoring is not routinely available, immunologic criteria are commonly used to determine treatment failure while on antiretroviral therapy (ART). However, few have studied CD4+ response and its relationship to subsequent clinical outcomes in a programmatic setting. Methods: We analyzed cohort data from Zambia to investigate whether 6- and 12-month CD4+ response after ART initiation was associated with later mortality. We used Cox proportional hazards models that accounted for different strata of baseline CD4+ counts and adjusted for age, sex, clinical stage, tuberculosis coinfection, baseline hemoglobin, initial ART regimen, and adherence behavior. Results: We analyzed data from 2 cohorts, from 6 months onward (n = 24,366; median follow-up = 467 days, interquartile range 222-791) and from 12 months onward (n = 17,920; median follow-up = 423 days, interquartile range 191-689). In the post-6-month analysis, hazard for death was significantly higher when absolute CD4+ response was + count was + cell count + cell count of + count at 12 months <100 per microliter (AHR = 4.11, 95% CI: 2.96 to 5.68). Conclusion: Commonly used definitions for immunologic treatment failure are associated with elevated mortality risk among patients on ART.

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