Abstract
Cluster of differentiation 4 (CD4) cell count recovery is used in determining disease progression and outcome monitoring. This study was conducted to determine the trends of CD4 cell count recovery, and its determinants in Hawassa university referral hospital, Ethiopia. Retrospective cohort study design was employed to gather relevant data among human immunodeficiency virus (HIV) positive-patients visiting Hawassa University referral hospital. Data were collected from December 1, 2014 to May 15, 2015. A total of 2400 medical records of adult patients aged above 15 years were examined. Of these, 1479 were evaluated and analyzed. Multivariate logistic regression was constructed to determine predictors of change in CD cell count. The median change in CD4 cell count from baseline to six months was 124 cells/μl. 19.3% of patients were at risk of immunologic non-response at 12 months of treatment. Patients with a baseline CD4 cell count of less than 100 cells/ml were 5 times more likely to exhibit immunologic non-response compared to those with a baseline CD4 cell count > 350 cells/μl. Baseline body mass index (BMI) and sex were associated with failure to attain ≥200 cells/μl at 12 months of treatment. Rapid recovery of CD4 cell count occurred during the first six months of treatment in this study. However, significant proportions of patients were at risk of immunologic non-response. Low baseline CD4 cell counts were predictive of non-response in this setting. The findings suggest that initiation of antiretroviral therapy (ART) at a CD4 cell count greater than 500 cells/μl is associated with better immune recovery. Key words: Antiretroviral therapy, CD4 cell count, HIV/AIDS, Ethiopia.
Highlights
Antiretroviral therapy (ART) began in Ethiopia in 2003, and was made freely available in 2005
Factors affecting Cluster of differentiation 4 (CD4) cell count recovery after ART is unclear in Ethiopia setting, this paper explores such factors
We present the overview of the trends of CD4 cell count recovery and its determinants in an Ethiopian patient population using routinely available clinical data
Summary
Antiretroviral therapy (ART) began in Ethiopia in 2003, and was made freely available in 2005. Revisions were issued in 2005, 2008 and 2014 to facilitate a rapid scale-up of the service (FDRE, 2014; FMOE, 2008; MoH, 2005) These guidelines recommended measurement of CD4 cell count every six months as a major tool for monitoring treatment outcome. Studies examining the association between baseline CD4 cell count and immune recovery following ART report conflicting results. Some studies have revealed that a significant percentage of HIV-infected patients who initiate therapy with a low baseline CD4 cell count do not achieve a normal CD4 cell count, even after a decade of effective treatment (Lange et al, 2002; García et al, 2004; Lederman et al, 2003; Kaufmann et al, 2002). The survival rates of human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) patients in Ethiopia can be improved given the factors responsible for death in Ethiopian cohort of patients initiating ART are well explored. We present the overview of the trends of CD4 cell count recovery and its determinants in an Ethiopian patient population using routinely available clinical data
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