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Non‐uptake of highly active antiretroviral therapy among patients with a CD 4 count < 350 cells/μ L in the UK
Author(s) -
Kober C,
Johnson M,
Fisher M,
Hill T,
Anderson J,
Bansi L,
Gompels M,
Palfreeman A,
Dunn D,
Gazzard B,
Gilson R,
Post F,
Phillips AN,
Walsh J,
Orkin C,
Delpech V,
Ainsworth J,
Leen C,
Sabin CA
Publication year - 2012
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2011.00956.x
Subject(s) - medicine , viral load , hazard ratio , proportional hazards model , absolute neutrophil count , antiretroviral therapy , immunology , human immunodeficiency virus (hiv) , gastroenterology , toxicity , confidence interval , neutropenia
Objectives Current B ritish HIV A ssociation ( BHIVA ) guidelines recommend that all patients with a CD 4 count <350 cells/μ L are offered highly active antiretroviral therapy ( HAART ). We identified risk factors for delayed initiation of HAART following a CD 4 count <350 cells/μ L . Methods All adults under follow‐up in 2008 who had a first confirmed CD 4 count <350 cells/μ L from 2004 to 2008, who had not initiated treatment and who had >6 months of follow‐up were included in the study. Characteristics at the time of the low CD 4 cell count and over follow‐up were compared to identify factors associated with delayed HAART uptake. Analyses used proportional hazards regression with fixed (sex/risk group, age, ethnicity, AIDS , baseline CD 4 cell count and calendar year) and time‐updated (frequency of CD 4 cell count measurement, proportion of CD 4 counts <350 cells/μ L , latest CD 4 cell count, CD 4 percentage and viral load) covariates. Results Of 4871 patients with a confirmed low CD 4 cell count, 436 (8.9%) remained untreated. I n multivariable analyses, those starting HAART were older [adjusted relative hazard ( aRH )/10 years 1.15], were more likely to be female heterosexual ( aRH 1.13), were more likely to have had AIDS ( aRH 1.14), had a greater number of CD 4 measurements < 350 cells/μ L ( aRH /additional count 1.18), had a lower CD 4 count over follow‐up ( aRH /50 cells/μ L higher 0.57), had a lower CD 4 percentage ( aRH /5% higher 0.90) and had a higher viral load ( aRH /log 10 HIV ‐1 RNA copies/ml higher 1.06). Injecting drug users ( aRH 0.53), women infected with HIV via nonsexual or injecting drug use routes ( aRH 0.75) and those of unknown ethnicity ( aRH 0.69) were less likely to commence HAART . Conclusion A substantial minority of patients with a CD 4 count < 350 cells/μ L remain untreated despite its indication.