Abstract
BackgroundIn resource-limited settings, changes in CD4 counts constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing. In this study, we quantified trends on CD4 counts in patients on highly active antiretroviral therapy (HAART) in a comprehensive health care clinic in Kenya between 2011 and 2017. We evaluated the rate of change in CD4 cell count in response to antiretroviral treatment. We further assessed factors that influenced time to treatment change focusing on baseline characteristics of the patients and different initial drug regimens used. This was a retrospective study involving 432 naïve HIV patients that had at least two CD4 count measurements for the period. The relationship between CD4 cell count and time was modeled using a semi parametric mixed effects model while the Cox proportional hazards model was used to assess factors associated with the first regimen change.ResultsMajority of the patients were females and the average CD4 count at start of treatment was 362.1 cell/mm^3. The CD4 count measurements increased nonlinearly over time and these trends were similar regardless of the treatment regimen administered to the patients. The change of logarithm CD4 cell count rises fast for in the first 450 days of antiretroviral initiation. The average time to first regimen change was 2142 days. Tenoforvir (TDF) based regimens had a lower drug substitution(aHR 0.2682, 95% CI:0.08263- 0.8706) compared to Zidovudine(AZT).ConclusionThe backbone used was found to be associated with regimen changes among the patients with fewer switches being observed, with the use of TDF when compared to AZT. There was however no significant difference between TDF and AZT in terms of the rate of change in logarithm CD4 count over time.
Highlights
IntroductionIn resource-limited settings, changes in CD4 counts constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing
Changes in CD4 count constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing
Adjusting for the baseline characteristics we find that only the backbone was associated with the drug regimen changes (aHR = 0.2682 (95% C.I: 0.08263− 0.8706e)) which was observed in the log-rank test
Summary
In resource-limited settings, changes in CD4 counts constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing. We further assessed factors that influenced time to treatment change focusing on baseline characteristics of the patients and different initial drug regimens used. This was a retrospective study involving 432 naïve HIV patients that had at least two CD4 count measurements for the period. After initiation of antiretroviral therapy(ART) most patients experience a reduction in HIV viral load combined with an increase in CD4 cell count which reduces the risk of HIV related events and death. Changes in CD4 count constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing. The measurements of CD4 in most developing countries is not on a regular basis
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