Abstract
Background: As one of the countries in the Sub-Saharan African Region, Ethiopia also happens to bear a higher burden of HIV infection. For HIV-infected patients, the level of CD4 count remains an important test with regard to diagnostic decision-making. There is limited information on predictors of longitudinal change in CD4 count over time that examine immunologic response of patients during the course of treatment in Ethiopia. Therefore, this study aimed to examine predictors of change in CD4 count among adult HIV infected patients on antiretroviral treatment in west Hararghe zone, Ethiopia. Methods: An institutional based retrospective cohort study was conducted among 405 adult HIV/AIDS patients on Anti-Retro Viral Therapy (ART) from September 2013 to January 2019. Data was entered into Epi info 7 and analyzed in R software. Generalized mixed effect model was applied to identify predictors of longitudinal change in CD4 count. Results: In multivariable analysis time since start of ART (beta=0.306, 95%CI, 0.286: 0.326), primary level educational status (beta=0.048, 95%CI, 0.004: 0.092), tertiary educational status (beta=0.094, 95%CI, 0.007: 0.182), WHO RVI stage II (beta=-0.108, 95%CI, -0.156:-0.061), bedridden functional status (beta=-0.175, 95%CI,-0.309:-0.039), poor baseline adherence (beta=-0.145, 95%CI, -0.214: -0.076) and baseline weight (beta=-0.004, 95%CI, -0.006, -0.002) were significant predictors of longitudinal CD4 change. Conclusion: In this study time since start of ART, primary and tertiary educational status contributed positively to the change in CD4 count whereas bedridden functional status, poor adherence, WHO RVI stage II and baseline weight are negatively associated with longitudinal change in CD4 count. Close monitoring for bedridden patients and patients with poor baseline adherence is needed especially during the initiation of ART for immunological response.
Highlights
37.9 million people are living with HIV until the end of 2018 of which 36.2 million are adults [1]
A total of 405 patients on Anti-Retro Viral Therapy (ART) who meet inclusion criteria were included in the study of which 61.23% were from Chiro Zonal Hospital and 38.77% were from Gelemso General Hospitals
Predictors of Longitudinal CD4 cell count change We fitted generalized linear mixed effect model with log link function to identify predictors of longitudinal CD4 count by adjusting for the effect of the covariates which were significantly associated with longitudinal change in CD4 in bi-variable analysis at p value of 0.2
Summary
37.9 million people are living with HIV until the end of 2018 of which 36.2 million are adults [1]. 33 Adisu Birhanu Weldesenbet et al.: Predictors of Change in CD4 Count among Adult HIV/AIDS Patients on Anti-Retroviral Treatment in West Hararghe Zone, Ethiopia; Retrospective Longitudinal Study advanced HIV disease need to be identified for prophylaxis against opportunistic infections and intensive monitoring for immune recovery. This study aimed to examine predictors of change in CD4 count among adult HIV infected patients on antiretroviral treatment in west Hararghe zone, Ethiopia. Results: In multivariable analysis time since start of ART (beta=0.306, 95%CI, 0.286: 0.326), primary level educational status (beta=0.048, 95%CI, 0.004: 0.092), tertiary educational status (beta=0.094, 95%CI, 0.007: 0.182), WHO RVI stage II (beta=-0.108, 95%CI, -0.156:-0.061), bedridden functional status (beta=-0.175, 95%CI,-0.309:-0.039), poor baseline adherence (beta=-0.145, 95%CI, -0.214: -0.076) and baseline weight (beta=-0.004, 95%CI, -0.006, -0.002) were significant predictors of longitudinal CD4 change. Close monitoring for bedridden patients and patients with poor baseline adherence is needed especially during the initiation of ART for immunological response
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