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1 Epicentre, Paris, France

Reaching 500 CD4 cells/μL is associated with higher survival after 9 months on ART in sub-Saharan African patients. Maman D 1,2 , Pujades-Rodr íguez M 1 , McGuire M 1 ,Nicholas S 1 , Ecochard R 2 , Etard JF 1. 1 Epicentre, Paris, France

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1 Epicentre, Paris, France

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  1. Reaching 500 CD4 cells/μL is associated with higher survival after 9 months on ART in sub-Saharan African patients Maman D1,2, Pujades-Rodríguez M1, McGuire M1,Nicholas S1, Ecochard R2, Etard JF1 1 Epicentre, Paris, France ² Hospices Civils de Lyon, Department of biostatistics, Lyon, France

  2. Study objectives • To explore factors associated with long term mortality (after the first 9 months of ART) • To determine the CD4 level duringtreatment associated with better survival

  3. Methods • 4 HIV programmes supported by MSF • Routine monitoring data (FUCHIA) • Inclusion criteria :Initiated ART btw 2001 & 2010, >15yo, ART naïve & followed-up for at least 9 months • Statistics: Survival analysis using mixed Poisson models

  4. Results: Patients baseline characteristics • 27,108 patients • (71,115.1 PY at risk) • Median time of follow-up: • 3.04 years [IQR 1.75 – 4.76] • Outcomes • Alive at end of follow-up • 23,300 (86.3%) • Deaths • 922 (3.4%) • Lost to follow-up • 2,796 (10.3%)

  5. Results Association between current CD4 counts and mortality after 9 months on ART, Kenya, Malawi and Uganda, 2001-2010, 77,970 CD4 values *Also adjusted by Age, Programmes, Adherence, Years of ART start, Baseline WHO stage, CD4 level and BMI

  6. Discussion • Reaching a CD4 count >500 cells/µL on ART is associated with increased survival. • Indirectly supports policies for earlier initiation of ART as patients would spend less time below 500 CD4 • Cause: More opportunistic infections below 500 CD4 cells/µL

  7. Operational implications • Starting patients earlier is feasible: • In 2008, 40% of new patients not eligible for ART (1/3 of them Lost to Follow-up within a year) • Starting patients earlier will eventually decrease the workload • A cohort= ART + pre-ART patients • After catch-up phase, same number of patients initiated

  8. Acknowledgements • Patients and their family • MSF and MOH staff • MSF medical department & desks • Epicentre, FUCHIA team • Biostatistiques unit: Hospices Civils de Lyon • Sidaction (grant BI20-3-01644)

  9. Thank you !!!

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