Predictors of Sub-Optimal CD4 Recovery during the First Six Months of Anti-Retroviral Treatment (ART) in HIV Infected Children: A Retrospective Cross Sectional Study from Tikur Anbessa Tertiary Hospital, Addis Ababa, Ethiopia (original) (raw)
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HIV/AIDS : Research and Palliative Care, 2020
Purpose: After the initiation of highly active antiretroviral therapy (HAART), successful HAART is characterized by an increase in the CD4 + count. Several factors affect the CD4 + T-cell count. This study aimed to assess the immunological response during HAART and determinants of the current CD4 + T-cell count among HIV/AIDS patients on HAART. Patients and Methods: A hospital-based cross-sectional study was conducted from February 1 to April 1, 2017. A total of 423 HIV/AIDS patients on HAART were enrolled using simple random sampling. Descriptive statistics, and bivariate and multiple regression analyses were conducted. Variables with p-value <0.2 in the bivariate analysis were entered in the multiple regression models. p-Values <0.05 and 95% confidence intervals were used to identify determinants of the current CD4 + T-cell count. Results: The mean CD4 + T-cell count gradually increased until 8 years on HAART but declined thereafter. An increased current CD4 + T-cell count was observed among patients with an initial regimen of pediatric d4T-3TC-NVP [β=185.5, 95% CI (8.8, 362.2)] (p=0.040), with increased baseline CD4 + T-cell count [β=0.468, 95% CI (0.342, 0.594)] (p<0.0001), and with long duration on HAART [β=18.0, 95% CI (9.9, 26.1)] (p<0.0001), whereas a decreased level of current CD4 + T-cell count was observed among males [β=−72.7, 95% CI (−114.5,-30.9)]) (p<0.0001) and those with poor baseline adherence [β=−108.9, 95% CI (−210.9, −7.0)] (p=0.036) and viral load >1000 copies [β=−189.2, 95% CI (−243.5, −134.9)] (p<0.0001). Conclusion: The trend in immunological response was not increased linearly throughout the HAART duration. Sex, type of initial regimen, baseline adherence, baseline CD4 + count, viral load, and duration on HAART were independent determinants of current CD4 + count. These determinants could be addressed by regular monitoring of HIV patients on HAART, and special attention should be paid to male patients.
HIV/AIDS - Research and Palliative Care, 2020
Background: Antiretroviral therapy has resulted in significant reductions in HIV-associated complications by recovering the CD4+ T cell count. Some patients may not be successful in attaining this result, and some may achieve it only after many years of treatment. Objective: This study aimed to assess CD4+ T cell recovery and non-response patterns among HAART experienced HIV-positive patients at the Arsi Negelle health center. Methods: This was a retrospective cross-sectional study conducted among HAART experienced HIV/AIDS patients at Arsi Negelle Health Center from January 01, 2014 to January 06, 2019. Data were documented to a data retrieval form and analyzed with SPSS version 20. Linear regression analysis was used to identify predictors of CD4 count change. A P-value of <0.05 was considered significant. Results: The total median of CD4+ T cells increased from 257 cells/uL at the baseline to 382 cells/uL after 6 months, then to 591 cells/uL after 60 months of treatment. The non-response rate was 22.1% and 23.8% among the total study participants and children of less than 15 years, respectively. Only baseline CD4+ T cell was associated with a change in CD4+ T cell count. Conclusion: From our study, we can conclude that CD4+ T cell count has recovered in most of the study participants after HAART initiation. The immunological non-response rate of study participants was 22.1% after 12 months on HAART and 7.2% at the end of the study.
HIV/AIDS - Research and Palliative Care, 2020
Purpose: After the initiation of highly active antiretroviral therapy (HAART), successful HAART is characterized by an increase in the CD4 + count. Several factors affect the CD4 + T-cell count. This study aimed to assess the immunological response during HAART and determinants of the current CD4 + T-cell count among HIV/AIDS patients on HAART. Patients and Methods: A hospital-based cross-sectional study was conducted from February 1 to April 1, 2017. A total of 423 HIV/AIDS patients on HAART were enrolled using simple random sampling. Descriptive statistics, and bivariate and multiple regression analyses were conducted. Variables with p-value <0.2 in the bivariate analysis were entered in the multiple regression models. p-Values <0.05 and 95% confidence intervals were used to identify determinants of the current CD4 + T-cell count. Results: The mean CD4 + T-cell count gradually increased until 8 years on HAART but declined thereafter. An increased current CD4 + T-cell count was observed among patients with an initial regimen of pediatric d4T-3TC-NVP [β=185.5, 95% CI (8.8, 362.2)] (p=0.040), with increased baseline CD4 + T-cell count [β=0.468, 95% CI (0.342, 0.594)] (p<0.0001), and with long duration on HAART [β=18.0, 95% CI (9.9, 26.1)] (p<0.0001), whereas a decreased level of current CD4 + T-cell count was observed among males [β=−72.7, 95% CI (−114.5,-30.9)]) (p<0.0001) and those with poor baseline adherence [β=−108.9, 95% CI (−210.9, −7.0)] (p=0.036) and viral load >1000 copies [β=−189.2, 95% CI (−243.5, −134.9)] (p<0.0001). Conclusion: The trend in immunological response was not increased linearly throughout the HAART duration. Sex, type of initial regimen, baseline adherence, baseline CD4 + count, viral load, and duration on HAART were independent determinants of current CD4 + count. These determinants could be addressed by regular monitoring of HIV patients on HAART, and special attention should be paid to male patients.
CD4 cell counts at the third month of HAART may predict clinical failure
AIDS, 1999
Objective: To evaluate the influence of immunological and virological markers on clinical outcome in patients receiving their first highly active antiretroviral therapy (HAART) regimen. Design and methods: Observational study of 585 patients initiating HAART in a clinical setting. Clinical failure was defined as the occurrence of new or recurrent AIDS-defining events or death, and was analysed by means of intention-to-treat, univariate and multivariate analyses. An adjusted Cox regression model was used to evaluate the effect of 3-month CD4 cell counts on clinical outcome. Results: Clinical failure occurred in 55 patients (9.4%) during a median follow-up of 483 days (range 33-1334 days): 45 new AIDS-defining events (ADEs) in 38, ADE recurrence in six, and death in 11. Twenty-four of the 45 new ADEs (53.4%) occurred during the first 3 months of HAART, and 11 of 45 (24.4%) in the presence of CD4 cell counts >200 × 10 6 cells/l. The mean (median, range) CD4 counts were 144 × 10 6 cells/l (128, 4-529) in patients with and 322 × 10 6 cells/l (288, 14-1162) in patients without clinical failure (P < 0.0001). Moreover, the proportion of patients with mean CD4 cell counts < 200 × 10 6 cells/l was higher in those experiencing subsequent clinical failure (χ 2 test: 26.75; P < 0.00001). Multivariate analysis showed that baseline CD4 cell counts < 50 × 10 6 cells/l and AIDS at enrolment predicted failure; after adjusting for 3-month CD4 cell counts, this marker was the only one independently associated with clinical failure (hazard risk, 4.79; 95% confidence interval, 1.40-16.47). Conclusions: The 3-month immunological response is a reliable predictor of longterm clinical outcome.
Biomedicine & Pharmacotherapy, 2001
The aim was to evaluate whether the three-month CD4 cell counts are a reliable predictor of the long-term clinical outcome of HAART-treated patients, by an observational study of 585 patients initiating HAART in a clinical setting. Clinical failure was defined as the occurrence of new or recurrent AIDS-defining events or death, and was analysed by means of intention-to-treat, univariate and multivariate analyses. An adjusted Cox regression model was used to evaluate the effect of threemonth CD4+ counts on clinical outcome. Clinical failure occurred in 65 patients (11.1%) during a median follow-up of 31 months (1-65) as a result of new AIDS-defining events (ADEs) in 48 patients, ADE recurrence in six, and death in 11. The mean (median; range) CD4+ counts were 156/µL (155; 4-529) in patients with and 362/µL (326; 18-1162) in patients without clinical failure (P < .0001). Moreover, the proportion of patients with mean CD4+ counts < 200 µL was higher in those experiencing subsequent clinical failure ( 2 : 41.11; P < .00001). Multivariate analysis showed that baseline CD4+ counts < 50 µL, HIV-RNA > 100,000 copies/mL and AIDS at baseline predicted failure; after adjusting for three-month CD4+ counts, this marker was the only one independently associated with clinical failure (HR 2.93; 95% CI: 1.16-7.38). The three-month immunologic response is a reliable predictor of long-term clinical outcome. © 2001 Éditions scientifiques et médicales Elsevier SAS HAART / long-term clinical failure / three-month CD4+ count
AIDS Research and Treatment, 2011
Background. CD4+ T-lymphocyte monitoring is not routinely available in most resource-limited settings. We investigated predictors of time to CD4+ T-lymphocyte recovery in HIV-infected children on highly active antiretroviral (HAART) at Korle-Bu Teaching Hospital, Ghana.Methods. Time to CD4+ T-lymphocyte recovery was defined as achieving percent CD4+ T-lymphocytes of 25%. We used Cox proportional hazard models for identifying significant predictor variables.Results. Of the 233 children with complete CD4+ T-lymphocyte data, the mean age at HAART initiation was 5.5 (SD=3.1) years. The median recovery time was 60 weeks (95% CL: 55–65). Evidence at baseline of severe suppression in CD4+ T-lymphocyte count adjusted for age, age at HAART initiation, gender, and having parents alive were statistically significant in predicting time to CD4+ T-lymphocyte recovery.Conclusions. A targeted approach based on predictors of CD4+ T-lymphocyte recovery can be a viable and cost-effective way of monito...
Biometrics & Biostatistics International Journal, 2016
Background: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) have caused the world most shocking tragedy and risk. Mortality among patients on HAART is associated with high baseline levels of HIV RNA, WHO stage III or IV at the beginning of treatment, low body mass index, severe anemia, low CD4+ cell count, type of ART treatment, gender, resource-poor settings, and poor adherence to HAART. Objective: The main objective of this study was to make use of appropriate modeling approach to CD4+ cell progression and identify the potential risk factors affecting the CD4+ cell progression of ART patients in Hossana District Queen Elleni Mohamad Memorial Hospital. Methods: In this longitudinal retrospective based study secondary data was used from Hossana District Queen Elleni Mohamad Memorial Hospital. The study population consists of 222 HIV-1-positive patients, measured repeatedly at least one time on each patient who are 15 years old or older those treated with ART drugs from September 2011 to May 2014. The data was analyzed using SAS 9.2 version procedure NLMIXED. Poisson, Poissongamma, Poisson-normal, and Poisson-normal-gamma models were applied to study overdispersion and correlation in the data. Results: A total of 222 adult ART HIV-1-positive patients were included in this study. Out of these ART patients, 131(59%) were female patients and 91(41%) were male patients; 65(29.30%) were followed the drug combinations properly; the mean and standard deviation of baseline CD4+ cell counts were 355.9 and 321.4 cells per milliliter of blood, respectively; the mean and standard deviation of age of patients (p=0.0001) were 31.06 and 8.50 years, respectively; patients were followed for a mean of 24 months (p=0.0001). The analysis showed that the covariates significant for the progression of CD4+ cell counts were age of the patient, time since seroconversion, and sex at 5% level of significance. Conclusion: On average CD4+ cell count increases after patients initiated to the HAART program (the disease rate declines). The progression of end outcome depends on patient's baseline socio-demographic characteristics. For the presence of over-dispersion, and clustering, the Poisson-normal-gamma model results in improvement in model fit.
Current HIV Research, 2009
A proportion of HIV-patients does not normally restore their CD4 counts despite virological response to HAART. Those whose CD4 counts persistently remain closed to the critical threshold for opportunistic infections deserve special interest. To study the risk factors, the long-term CD4 counts evolution, and the risk of death of patients who persistently maintain low CD4 counts, despite virological response to HAART, within a multicenter, hospital-based cohort study. A total of 147 patients were selected from CoRIS-MD and classified into a "Low-Group" or a "High-Group", depending on their CD4 counts after two-years of effective HAART (threshold 250 cells/ L). Associated risk factors were analysed by logistic regression, the CD4 dynamics were evaluated over a total period of 7.70 years (IQR, 6.70-9.00), and mortality was estimated by Cox proportional hazard. A total of 40 patients (27%) were classified into the "Low-Group". The odds ratio for this group increased with age, being 4.56 (2.23-9.33) for over 40, and was also higher among IDU, 3.63 (1.04-12.68). Six years thereafter, among these patients, only a 30% exceeded 350 CD4 cells/ L and a 12% exceeded 500 CD4 cells/ L. Furthermore, the "Low-Group" had a death rate of 2.42 per 100 persons/year (95%CI, 1.01-5.81), although once adjusted by age the estimates were no longer significant [4.14 (0.87-19.72)]. Our results suggest that those HIV patients who have not overcome the critical threshold of 250 CD4 cells/ L after a two years period of virologically effective HAART do persist with the aforementioned failure of CD4 restoration for a much longer time.