The secular trend in CD4+ T cell count at initiation of antiretroviral therapy in China

Abstract Background: We aimed to look at the trends in CD4 cells counts (at initiation of ART) over calendar years and to investigate its influential factors in Chinese populations.Methods: We searched PubMed, Wanfang, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure to acquire relevant papers published from January 2002 to Twelve 2015. We abstracted the mean or median CD4+ T cell counts from the included studies. Random-effect meta-regressions were used to estimate the mean CD4+ T cell counts across studies and corresponding 95% CIs. Results: A total of 220 eligible articles, which included 426283 HIV-positive individuals, were identified in this meta-analysis. The mean CD4+ T cell counts at ART initiation increased from 136.63 (95%CI=120.63–152.63) cells/µL in 2003 to 199 (95%CI=188.38–209.62) cells/µL in 2014. In the univariate meta-regression model, we found that the estimated change in CD4+ T cell counts at ART initiation was +8.73 cells/μL per year (95% CI= 4.57 to 12.90 cells/μL per year). The highest CD4+ T cell counts at ART initiation (441.00 cells/μL, 95% CI=438.96-186.33 cells/µL) was reported in serodiscordant couples, followed by pregnant women (385.82 cells/μL, 95% CI=327.19-444.44 cells/µL), MSM (293.78, 95% CI=126.59-460.96 cells/µL), and children（267.36 cells/μL, 95% CI=126.65-408.07 cells/µL）. Conclusions: In China, the CD4+ T cell counts at ART initiation have dramatically increased during the past decade. However, there remains a substantial gap between CD4+ T cell counts at ART initiation and the WHO updated HIV treatment guidelines in some groups, highlighting the need for strategies to improve earlier ART initiation.