Association between Gender Differences and Cd4 immunological Failure Among Human Immunodeficiency Virus Treatment Naïve Patients On Antiretroviral Therapy At Itezhi-Tezhi District Hospital (original) (raw)
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AIDS Research and Human Retroviruses, 2012
The Tshepo study was the first clinical trial to evaluate outcomes of adults receiving nevirapine (NVP)-based versus efavirenz (EFV)-based combination antiretroviral therapy (cART) in Botswana. This was a 3 year study (n = 650) comparing the efficacy and tolerability of various first-line cART regimens, stratified by baseline CD4 + : < 200 (low) vs. 201-350 (high). Using targeted maximum likelihood estimation (TMLE), we retrospectively evaluated the causal effect of assigned NNRTI on time to virologic failure or death [intent-to-treat (ITT)] and time to minimum of virologic failure, death, or treatment modifying toxicity [time to loss of virological response (TLOVR)] by sex and baseline CD4 +. Sex did significantly modify the effect of EFV versus NVP for both the ITT and TLOVR outcomes with risk differences in the probability of survival of males versus the females of approximately 6% (p = 0.015) and 12% (p = 0.001), respectively. Baseline CD4 + also modified the effect of EFV versus NVP for the TLOVR outcome, with a mean difference in survival probability of approximately 12% (p = 0.023) in the high versus low CD4 + cell count group. TMLE appears to be an efficient technique that allows for the clinically meaningful delineation and interpretation of the causal effect of NNRTI treatment and effect modification by sex and baseline CD4 + cell count strata in this study. EFV-treated women and NVP-treated men had more favorable cART outcomes. In addition, adults initiating EFV-based cART at higher baseline CD4 + cell count values had more favorable outcomes compared to those initiating NVP-based cART.
Do gender differences in CD4 cell counts matter?
AIDS, 1999
To examine the effect of gender on disease progression and whether gender differences in CD4 lymphocyte counts persisted for the entire course from HIV seroconversion until (death from) AIDS. Methods: CD4 lymphocyte counts were modelled in 221 female and 443 male seroconverters following seroconversion, backwards from AIDS and backwards from death using regression analysis for repeated measurements. Results: In the period before use of highly active antiretroviral therapy (HAART), progression to AIDS and to death were marginally slower in women than in men as assessed by proportional hazards analysis. Women seroconverted for HIV, developed AIDS and died at higher CD4 cell counts than men (women: 815, 146 and 44 X 10 ('cells/I, respectively; men: 727, 49 and 22 X 10 6 cells/I, respectively), although differences were only statistically significant at AIDS onset. Declines in CD4 lymphocyte counts were not significantly affected by gender and absolute differences between men and women were stable, with exception for the trajectory close to AIDS when the decline became steeper for men than women. Conclusion: These gender differences in CD4 lymphocyte counts suggest a delay of initiation of therapy in women compared with men (our model predicted that women reach the threshold of starting HAART at about 12 months later than men). If this delay unfavourably influences progression, treatment guidelines should be revised so that women can benefit equally from HAART.
Predictors of CD4+ Count Changes in HIV-Infected Patients Receiving Antiretroviral Therapy
Research Square (Research Square), 2022
Introduction The CD4 + count is used to evaluate the clinical status of HIV-infected patients when deciding whether to initiate ART. To study the progression of HIV-infected patients on ART, CD4 + counts in each individual could be measured repeatedly to monitor the patient's AIDS progression and monitor treatment success. Therefore, this study aimed to identify predictors of CD4 + progression in HIV-positive patients receiving ART at the Debre Berhan Referral Hospital. Methods Retrospective data were collected from 322 HIV-infected patients who started ART in the hospital from September 2013 to February 2019. Exploratory analyses were applied to assess subject-speci c and mean differences in terms of patients' CD4 + progression. A linear mixed model was used as data analysis to account random effects. Results Of the 322 HIV-infected patients considered in the study, 225 (69.88%) were females. The baseline mean CD4 + counts was 335.7 and changed to 408.61 over 7 follow-up years. Moreover, predictors such as patients' gender (male) (β =-0.7512, p-value = 0.019), age at initiation of ART (β =-0.02705, p-value = 0.047), bedridden functional status of the patients at initiation of ART (β =-0.03365, p-value = 0.021), TDF-3TC-NVP regimen class (β =-0.1474, p-value = 0.031), unmarried patients (β = 0.610, p-value = 0.011), patients' WHO clinical stage-II (β =-0.402, p-value = 0.047), baseline CD4 count (β = 0.020, p-value = 0.0001) and follow-up time (β = 0.613, p-value = 0.0001) were positively as well as negatively associated and had signi cant impact on CD4 count progression. Conclusions Patients' gender, age at initiation of ART, bedridden functional status at ART initiation, TDF-3TC-NVP treatment class, unmarried marital status, WHO clinical stage II, baseline CD4 count and follow-up time was found to be a signi cant predictor of the progression of a patient's CD4 count. Therefore, HIVpositive patients can be advised to start ART treatment as early as possible. Special guidance and attention is also required, especially in elderly patients, males with bedridden functional status, and late WHO clinical stage patients.
Journal of Medical and Allied Sciences, 2016
The present study aimed at serial three year assessment of CD4 cell response after initiation of anti-retroviral therapy (ART) in patients with HIV/AIDS attending to Osmania General Hospital. It was a retrospective hospital based observational study. Data was collected over a period of 3 years from 2005 to 2007 in the ART Centre, Department of Medicine, Osmania General Hospital. We included 110 HIV/AIDS who were on ART. Serial monitoring of CD4 count was done and assessed. All patients were on ART as per National Aids Control Organisation (NACO) guidelines. Investigations included complete blood picture, serum creatinine, blood urea, serum electrolytes, liver function tests, sputum for acid fast bacilli, chest radiography, CD4 cell count and if required fine needle aspiration and biopsy, magnetic resonance imaging, computerized tomography, colonoscopy were also performed. The result of the present study shows increase in mean CD4 count by 128.78 cells/mm 3 after 6 months of initiation of ART, 24.77 cells/mm 3 after 1 year, 67.53 cells/mm 3 after 2 years and 5.59 cells/mm 3 after 3 years from the base line CD4 cell count. It certainly reveals the improvement in the CD4 count after ART initiation. Improvement in CD4 count was almost equal in both male and female and in all age groups. Mean CD4 cell count improved by 240.31 cells/mm 3 in females and 220.54 cells/mm 3 in males from the baseline after 3 years of treatment with ART. The present study clearly shows definite improvement in CD4 cell count after ART of more than 100% irrespective of age and sex. Regular intake of drugs will improve immunologic response. Therefore, strict adherence to ART and regular counselling sessions at ART centres should be stressed upon.