Immune recovery among HIV-infected patients in northwestern Tanzania after 2 years of anti-retroviral therapy use: a retrospective cohort study (original) (raw)
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Journal of Pharmaceutical & Scientific Innovation, 2015
The initiation of ART is best based on CD4 cell count, a marker of immune status, rather than on viral load, a marker of virologic replication. For patients with advanced symptoms, treatment should be started regardless of CD4 count. However, the point during the course of HIV infection at which antiretroviral therapy (ART) is best initiated in asymptomatic patients remains unclear. The objective of this study is to assess ART treatment outcomes verses CD4 count threshold among HIV/AIDS patients in Ras Desta hospital. This was a periodic retrospective cross sectional study of HIV positive patient's ART treatment outcomes in relation to CD4 count threshold in Ras Desta hospital. From all HIV positive patients who had registered for ART from September 2009-February 2011 at Ras Desta hospital, 636 patients had met the criteria of the study and they were selected. Out of the 636 patients chosen for the study, 372 (58.5 %) were females while 264 (41.5 %) were males. For the whole sample under study, the median age was 36 years. Out of 636 patients 504 patients had a CD4 count less than 200 cells /mm 3 , 120 had a CD4 count greater than 200 and less than 350 cells/µl. Lastly, a total of 12 patients had a CD4 count greater than 350 cells /mm 3 at the initiation of ART. Other findings show that for all patients in the study receiving ART, median weight was 53 Kg (range 27 kg to 93 kg). Four hundred eighty (75.5 %) patients were alive, twenty one (3.3 %) patients had transferred out, 67 (10.5 %) were lost to follow-up and 68 (10.7 %) had died during two year period of ART use. A further observations of the deaths revealed that 53 (78 %) were CD4 count less than 200 cells/µl, 14 (20.5 %) patients were CD4 count > 200 and < 350 cells/µl, while only 1 (1.5 %) of the patient were died whose CD4 count > 350 cells/µl. This study show that early initiation of ART at CD4 levels higher than 200 cells/µl reduces mortality, immune-depression and weight loss and also improve outcome of ART treatment in asymptomatic, ART-naive, HIV-infected people. Practitioners and policy-makers may consider initiating ART at levels > 200 cells/ µl.
Aids Research and Therapy, 2009
Background Many HIV-infected patients only access health care once they have developed advanced symptomatic disease resulting from AIDS Defining Conditions (ADCs). We carried out a study to establish the effect of ADCs on immunological recovery among patients initiated on antiretroviral therapy (ART). Methods A retrospective cohort of 427 HIV-1 patients who were initiated on ART between January 2002 and December 2006 was studied. Data on ADCs was retrieved from Joint Clinical Research Centre (JCRC) data base and backed up by chart reviews. We employed Kaplan-Meier survival curves to estimate median time to 50 CD4 cells/μl from the baseline value to indicate a good immunological recovery process. Cox proportional hazard models were used at multivariate analysis. Results The median time to gaining 50 CD4 cells/μl from the baseline value after ART initiation was longer in the ADC (9.3 months) compared to the non-ADC group (6.9 months) (log rank test, p = 0.027). At multivariate analysis after adjusting for age, sex, baseline CD4 count, baseline HIV viral load, total lymphocyte count and adherence level, factors that shortened the median time to immunological recovery after ART initiation were belonging to the non-ADC group (HR = 1.31; 95% CI: 1.03–1.28, p = 0.028), adherence to ART of ≥ 95% (HR = 2.22; 95% CI: 1.57–3.15, p = 0.001) and a total lymphocyte count ≥ 1200 cells/mm3 (HR = 1.84; 95% CI: 1.22–2.78, p = 0.003). A low baseline CD4 count of ≤ 200 cells/μl (HR = 0.52; 95% CI: 0.37–0.77, p = 0.001) was associated with a longer time to immunological recovery. There was no interaction between low CD4 counts and ADC group. Conclusion Patients with ADCs take longer to regain their CD4 counts due to the defect in the immune system. This may prolong their risk of morbidity and mortality.
Immunological response among HIV/AIDS patients before and after ART therapy at
Background: HIV is isolated in 1983, human immunodeficiency Virus (HIV), the agent that causes acquired immune deficiency syndrome (AIDS), is classified as members of the lentivirus subfamily of retroviruses. Although HAART is known to profoundly suppress viral replication, it increases CD4 cell count and delays disease progression and death; patients on Highly Active Antiretroviral Therapy (HAART) commonly suffer from side effects of the drug. Each antiretroviral drug is associated with specific adverse effects.
The Journal of antimicrobial chemotherapy, 2017
We assessed factors, including treatment course, associated with failure to obtain a 10 year immunological response after starting first-generation PI-containing combined ART (cART). In the prospective COPILOTE cohort of HIV-infected patients started on a first-generation PI-containing regimen in 1997-99, the impact of cART history on the failure to achieve immunological response measured at 10 years was assessed by multivariate logistic regression models in the 399 patients with clinical and virological success of cART. Failure of CD4 response (CD4 >500/mm(3)) was associated with age ≥40 years at baseline (P < 0.001), CD4 cell counts ≤500/mm(3) at month 4 (P = 0.016) or month 12 (P < 0.001) and ≥3 months of cART interruption (P = 0.016). Factors associated with failure to achieve complete immunological response (CD4 >500/mm(3) and CD4:CD8 ratio >1) were CD4:CD8 ratio ≤0.8 at month 8 (P < 0.001) or month 12 (P < 0.001), ≥3 months of cumulative cART interruption ...
Evaluation of the Trend of CD4 Cell Count Over Time in Case of HIV/AIDS Patients under ART Follow-up
Journal of Scientific Research and Reports, 2019
Background: Globally 36.7 million people living with HIV, 1.8 million new HIV infection, and 1 million AIDS-related deaths in 2016.Patient mortality was high during the first 6 months after therapy for all patient subgroups and exceeded 40 per 100 patient years among patients who started treatment at low CD4 count. The aim this study was to evaluate the trend of CD4 cell count over time and to determine the progress of patient characteristics measured at baseline on CD4 cell count of HIV-infected patients who were under ART treatment in Arba Minch Hospital. Methods: This study was retrospective follow up study using data extracted from medical records, patient interviews, and laboratory work-up. The study was employed among 550 adult patients that were selected by simple random sampling. The continuous outcome variable CD4 cell count has measured at months 0, 6, 12, 18, and 24. Longitudinal data analysis were used because the set of measurements on one patient tend to be correlated,...
Journal of AIDS and HIV Research, 2020
In resource limited countries, there is scarcity of information regarding the degree of immunological and clinical recovery in remote communities with ART service. This study retrospectively assessed the degree of immune recovery by CD4 count after initiation of ART. A retrospective cohort study was conducted on adult HIV patients who have been on ART for more than one year at Karamara Hospital. All analyses were performed using SPSS software version 19.0 and findings were compared using the appropriate statistical tests. The median change from baseline to the most recent CD4 cell count was 141 cells/μl. By 5 years, the overall median CD4 cell count was 472 cells/μl while the median CD4 cell count was 401 cells/μl among patients with baseline CD4 cell counts ≤100 cells/μl, 467 cells/μl among those with baseline CD4 cell counts of 100 to 199 cells/μl, and 586 cells/μl among those with baseline CD4 cell counts equal to greater 200 cells/μl. At the end of the study, patients with higher baseline CD4 cell stratum returned to normal CD4 cell counts compared to those with the least baseline CD4 cell stratum. The findings suggest that consideration be given to initiation of ART at a CD4 cell count >350 cells/μl to achieve better immune recovery.
BMC Infectious Diseases, 2018
Background: The need to study the outcome of Antiretroviral Therapy (ART) among Human Immunodeficiency Virus (HIV) infected individuals in Ghana, a sub-Saharan African country crucial in the era of the "Treat All" policy. The aim of this study was to analyze selected determinants of immunological and virological response to ART among HIV infected individuals in a tertiary facility in Cape Coast, Ghana. Methods: An analytical cross sectional study with a retrospective component was conducted in the Cape Coast Teaching Hospital (CCTH), Central Region. Clients aged 18 years and above attending the HIV Clinics for ART and who were on ART for 6 months or more were recruited. The viral loads, CD4 count and other socio-demographic data were analyzed using STATA version 13 (STATA Corp, Texas USA). Descriptive analysis was done and presented with appropriate measures of central tendencies. In addition, bivariate and multivariate analysis was carried out with p value of 0.05 interpreted as evidence of association between variables. Results: A total of 440 participants were included in this study with a mean age of 45.5 (±11.6) years. The mean CD4 count at baseline, 6 months on ART and currently at study recruitment were 215.1 cells/mm 3 (±152.6), 386.6 cells/mm 3 (±178.5), and 579.6 cells/mm 3 (±203.0) respectively. After 6 months and 12 months on ART, the number who had achieved viral copies < 1000/ml were 149 (47.0%) and 368 (89.6%) respectively. There was strong evidence of an association between having CD4 count < 350 cells/mm 3 after 6 months on ART and having a diagnosis of tuberculosis since HIV diagnosis (aOR 8.5, 95% CI 1.1-73.0, p = 0.05) and clients having plasma viral load > 1000 copies/ml after 6 months on ART (aOR 2.0, 95% CI 1.2-3.2, p = 0.01). Conclusion: There was good response to ART among clients, high virological suppression and immunological recovery hence low rates of change to second line ART regimen in this cohort studied. With strict adherence to the national policy on HIV testing, management of positive clients and full implementation of the "Treat All" policy, Ghana could achieve, if nothing at all, the third "90, 90, 90" target by 2020.
BMC infectious diseases, 2006
Patients accessing antiretroviral treatment (ART) programmes in sub-Saharan Africa frequently have very advanced immunodeficiency. Previous data suggest that such patients may have diminished capacity for CD4 cell count recovery. Rates of CD4 cell increase were determined over 48 weeks among ART-naïve individuals (n = 596) commencing ART in a South African community-based ART programme. The CD4 cell count increased from a median of 97 cells/microl at baseline to 261 cells/microl at 48 weeks and the proportion of patients with a CD4 cell count < 100 cells/microl decreased from 51% at baseline to just 4% at 48 weeks. A rapid first phase of recovery (0-16 weeks, median rate = 25.5 cells/microl/month) was followed by a slower second phase (16-48 weeks, median rate = 7.7 cells/microl/month). Compared to patients with higher baseline counts, multivariate analysis showed that those with baseline CD4 counts < 50 cells/microl had similar rates of phase 1 CD4 cell recovery (P = 0.42), g...