Imperial College London
Alternate

ProfessorSimonGregson

Faculty of Medicine, School of Public Health

Professor in Demography and Behavioural Science
 
 
 
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Contact

 

+44 (0)20 7594 3279s.gregson

 
 
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Location

 

LG27Praed StreetSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Mangal:2017:10.1097/QAD.0000000000001437,
author = {Mangal, TD and UNAIDS, Working Group on CD4 Progression and Mortality Amongst HIV Seroconverters including the CASCADE Collaboration in EuroCoord},
doi = {10.1097/QAD.0000000000001437},
journal = {AIDS},
pages = {1073--1082},
title = {Joint estimation of CD4+ cell progression and survival in untreated individuals with HIV-1 infection.},
url = {http://dx.doi.org/10.1097/QAD.0000000000001437},
volume = {31},
year = {2017}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - OBJECTIVE: We compiled the largest dataset of seroconverter cohorts to date from 25 countries across Africa, North America, Europe, and Southeast/East (SE/E) Asia to simultaneously estimate transition rates between CD4 cell stages and death, in antiretroviral therapy (ART)-naive HIV-1-infected individuals. DESIGN: A hidden Markov model incorporating a misclassification matrix was used to represent natural short-term fluctuations and measurement errors in CD4 cell counts. Covariates were included to estimate the transition rates and survival probabilities for each subgroup. RESULTS: The median follow-up time for 16373 eligible individuals was 4.1 years (interquartile range 1.7-7.1), and the mean age at seroconversion was 31.1 years (SD 8.8). A total of 14525 individuals had recorded CD4 cell counts pre-ART, 1885 died, and 6947 initiated ART. Median (interquartile range) survival for men aged 20 years at seroconversion was 13.0 (12.4-13.4), 11.6 (10.9-12.3), and 8.3 years (7.9-8.9) in Europe/North America, Africa, and SE/E Asia, respectively. Mortality rates increase with age (hazard ratio 2.22, 95% confidence interval 1.84-2.67 for >45 years compared with <25 years) and vary by region (hazard ratio 2.68, 1.75-4.12 for Africa and 1.88, 1.50-2.35 for Asia compared with Europe/North America). CD4 cell decline was significantly faster in Asian cohorts compared with Europe/North America (hazard ratio 1.45, 1.36-1.54). CONCLUSION: Mortality and CD4 cell progression rates exhibited regional and age-specific differences, with decreased survival in African and SE/E Asian cohorts compared with Europe/North America and in older age groups. This extensive dataset reveals heterogeneities between regions and ages, which should be incorporated into future HIV models.
AU  - Mangal,TD
AU  - UNAIDS,Working Group on CD4 Progression and Mortality Amongst HIV Seroconverters including the CASCADE Collaboration in EuroCoord
DO  - 10.1097/QAD.0000000000001437
EP  - 1082
PY  - 2017///
SN  - 0269-9370
SP  - 1073
TI  - Joint estimation of CD4+ cell progression and survival in untreated individuals with HIV-1 infection.
T2  - AIDS
UR  - http://dx.doi.org/10.1097/QAD.0000000000001437
UR  - http://www.ncbi.nlm.nih.gov/pubmed/28301424
UR  - http://hdl.handle.net/10044/1/45932
VL  - 31
ER  -
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