Immunological recovery, failure and factors associated with CD-4 T-cells progression over time, among adolescents and adults living with HIV on Antiretroviral Therapy in Northern Ethiopia: Aretrospective cross sectional study.

Abraham Aregay Desta,Nesredin Futwi,Hagos Godefay,Tewolde Wubayehu Woldearegay,Asfawosen Aregay Berhe,Goyitom Gebremedhn Gebru,Robert Güerri-Fernández

doi:10.1371/journal.pone.0226293

Abstract

BackgroundThis study was aimed to assess immunological recovery, failure, and factors associated with CD-4 T-cells progression over time, among adolescents and adults living with HIV on Antiretroviral Therapy in Northern Ethiopia.MethodsA retrospective cross sectional study was done on 19,525 HIV patients on ART. Data were collected using a data retrieval checklist from a database. All eligible data in the database were exported to Microsoft excel 2010 and then data verification and filtration were done before exporting to STATA 14.0 for analysis. Factors associated with recent CD-4 count were modeled by using Generalized Linear Model poison family.ResultsAmong the patients with advanced HIV infection (< 200 CD-4 T-cell/ mm3) at baseline, only 28.35%, 95% CI (27.45–29.26) of them had immunological recovery (≥ 500 T-cells/mm3). Only 2.14%, 95%CI (1.94%- 2.35%) of the patients had immunological failure. Baseline CD-4 count (Incidence Rate Ratio (IRR) = 1.0007, 95%CI = 1.00069–1.00078), patients from military health care facility (IRR = 1.11, 95%CI = 1.06–1.16), good adherence (IRR = 1.12, 95%CI = 1.04–1.21) and viral load suppression (IRR = 1.31, 95%CI = 1.28–1.33) were positively associated with recent CD-4 count in the full model. Whereas, being male (IRR = 0.85, 95%CI = 0.83–0.86), patients with on Anti-Retroviral Therapy (ART) regimen of 1e (TDF-3TC-EFV), 2f (AZT-3TC-ATV/r), and 2h (TDF-3TC-ATV/r) (IRR = 0.92, 95%CI = 0.91–0.94), (IRR = 0.65, 95%CI = 0.55–0.76) and (IRR = 0.71, 95%CI = 0.63–0.81) respectively were negatively associated with the recent CD-4 count in the full model.ConclusionsImmunological recovery was achieved by 1/3 of the patients despite being on highly active ART (HAART). Therefore, intensive adherence counseling, follow-up and support should be focused on patients with viral non suppression to enhance immunological recovery.

Highlights

Around 36.9 million people were living with HIV and about 21.7 million people were on highly active Anti-Retroviral Therapy (ART) (HAART) in 2017
There were 1.8 million people who were newly infected with HIV and 940,0000 people died from Acquired Immune Deficiency Syndrome (AIDS) related illnesses in 2017 [1]
A retrospective cross sectional study was conducted from April, 2015 to January, 2019 at Tigray Health Research Institute (THRI) which is the only center for Viral Load (VL) determination

Summary

Introduction

Around 36.9 million people were living with HIV and about 21.7 million people were on HAART in 2017. There were 1.8 million people who were newly infected with HIV and 940,0000 people died from Acquired Immune Deficiency Syndrome (AIDS) related illnesses in 2017 [1]. It was estimated that a total of 64,791 people were living with HIV in Tigray region [3]. Anti-Retroviral Therapy (ART) coverage in Ethiopia was moderate (52%) [4], 86% and 20% among adult and child population respectively [5]. There are 39,960 patients on ART care (61.7% coverage) in Tigray [3]. This study was aimed to assess immunological recovery, failure, and factors associated with CD-4 T-cells progression over time, among adolescents and adults living with HIV on Antiretroviral Therapy in Northern Ethiopia

Objectives

Methods

Results

Conclusion