Antiretroviral Therapy Initiation and CD4 Progression over time among HIV Infected Adults in Central Africa

An improved understanding of CD4 progression over time in resource-limited settings may aid in the discussion of when to initiate antiretroviral therapy (ART) and optimal timing for CD4 monitoring. We examined CD4 progression over time among 347 HIV-positive adults from 10 HIV care and treatment programs in Burundi, Cameroon, and the Democratic Republic of Congo (DRC). We applied a mixed model using restricted maximum likelihood to describe CD4 cell count evolution over time following ART initiation and to evaluate the association between other baseline variables and CD4 response over time. Depending on the initial baseline CD4 count, increases in mean CD4 cell count ranged from 24–46 cells/mm 3 from 3 to 6 months after treatment initiation, and from 80–117 from 6 to 18 months after treatment initiation. Females had higher CD4 count at the initiation of treatment than males. Patients with higher CD4 count at ART initiation achieved a higher CD4 count in the following months. We found that higher baseline CD4 cell counts predicted higher CD4 cell counts over time among the patients eligible for this analysis. We also observed increases in mean CD4 cell count from 3 to 18 months after treatment initiation.