CD4 counts and viral loads of newly diagnosed HIV-infected individuals: implications for treatment as prevention

Sarishen Govender; Kennedy Otwombe; Thandekile Essien; Ravindre Panchia; Guy de Bruyn; Lerato Mohapi; Glenda Gray; Neil Martinson

doi:10.1371/journal.pone.0090754

CD4 counts and viral loads of newly diagnosed HIV-infected individuals: implications for treatment as prevention

PLoS One. 2014 Mar 4;9(3):e90754. doi: 10.1371/journal.pone.0090754. eCollection 2014.

Authors

Sarishen Govender¹, Kennedy Otwombe², Thandekile Essien², Ravindre Panchia², Guy de Bruyn², Lerato Mohapi², Glenda Gray², Neil Martinson³

Affiliations

¹ Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa; Canada-Africa Prevention Trials Network, The Ottawa Hospital General Campus, Ottawa, Canada.
² Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa.
³ Perinatal HIV Research Unit (PHRU), University of the Witwatersrand and Baragwanath Hospital, Soweto, South Africa; Johns Hopkins University, Center for TB Research, Baltimore, Maryland, United States of America.

Abstract

Objective: To report the viral load and CD4 count in HIV-infected, antiretroviral naïve, first -time HIV-testers, not immediately eligible for treatment initiation by current South Africa treatment guidelines.

Design: This was a cross-sectional study in a high-volume, free-of-charge HIV testing centre in Soweto, South Africa.

Methods: We enrolled first time HIV testers and collected demographic and risk-behaviour data and measured CD4 count and viral load.

Results: Between March and October 2011, a total of 4793 adults attended VCT and 1062 (22%) tested positive. Of the 1062, 799 (75%) were ART naïve and 348/799 (44%) were first-time HIV testers. Of this group of 348, 225 (65%) were female. Overall their median age, CD4 count and viral load was 34 years (IQR: 28-41), 364 (IQR: 238-542) cells/mm3 and 13,000 (IQR: 2050-98171) copies/ml, respectively. Female first time HIV testers had higher CD4 counts (419 IQR: 262-582 vs. 303 IQR: 199-418 cells/mm3) and lower viral loads (9,100 vs. 34,000 copies/ml) compared to males. Of 183 participants with CD4 count >350 cells/mm3, 62 (34%) had viral loads > 10,000 copies/ml.

Conclusions: A large proportion of HIV infected adults not qualifying for immediate ART at the CD4 count threshold of 350 cells/mm3 have high viral loads. HIV-infected men at their first HIV diagnosis are more likely to have lower CD4 counts and higher viral loads than women.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count*
Cross-Sectional Studies
Female
HIV / isolation & purification*
HIV Infections / diagnosis*
HIV Infections / epidemiology
HIV Infections / immunology*
HIV Infections / prevention & control
Humans
Male
Middle Aged
South Africa / epidemiology
Viral Load*

Grants and funding

This study was funded by Canadian African Prevention Trials Network (CAPT) and Presidents Emergency Plan For AIDS Relief (PEPFAR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. KO has received research training from the Fogarty International Center (TW007373/0).