Abstract
Background: Highly active anti-retroviral therapy (HAART) has brought significant change in reducing morbidity and mortality among children living with HIV/AIDS. Decisions concerning initiation and/or shifting of antiretroviral therapy (ART) are guided by monitoring the laboratory parameters of plasma HIV RNA (viral load) and CD4+ T cell count in addition to the patient’s over all clinical response. The demonstrations of the prognostic value of the CD4 cell count was of major importance in the development of therapeutic strategies. Therefore, the objective of this study was to assess factors predicting suboptimal CD4 cell recovery during first six months of ART. Methods: The study is retrospective cross sectional study to assess factors predicting suboptimal CD4 cell recovery. Medical records of patients’ were retrieved and important variables are captured to standard questionnaire tool. T-test is used to assess changes in CD4 cell count after initiation of ART. Binary logistic and multiple regressions were used to assess factors predicting CD4 cell recovery. Results: Data of 360 children were analyzed. CD4 cell count at the start of HAART ranged from 3-2003 cell/mL with an interquartile range of 231-317 cell/mL. After 6 months of HAART, the CD4 cell count has increased ranging from 71-2300 cell/mL with inter quartile range of 458-612 cell/mL and mean CD4 cell count difference of 230, 95%CI (199.414-260.613); P<0.001. Advanced clinical stage of the disease, severe degree of immunosupression, presence of anemia, presence of chronic diarrhea at base line, poor weight gain during first six months of HAART adversely affect the trends of CD4 recovery. Conclusion: Our study demonstrated that advanced clinical stage of the disease, severe degree of immunosupression, presence of anemia at baseline and presence of chronic diarrhea, poor weight gain during first six months of HAART were factors adversely affect the trends of CD4 recovery.
Highlights
More than 2 million children are living with HIV/Acquired Immunodeficiency Syndrome (AIDS) worldwide and more than 90% of them are living in sub-Saharan Africa [1]
Active anti-retroviral therapy (HAART) has brought significant change in reducing morbidity and mortality among children living with HIV/AIDS
Anemia was detected in 16.3% (61/360) of patients at the start of Highly active anti-retroviral therapy (HAART) with the majority of the cases having a mild degree of anemia accounting for 81% (49/61) of the cases of anemia (Table 1)
Summary
More than 2 million children are living with HIV/AIDS worldwide and more than 90% of them are living in sub-Saharan Africa [1]. Only 10% of HIVinfected pregnant ladies are offered any form of prevention of mother to child HIV transmission (PMTCT) in sub-Saharan countries [1,2]. Based on the 2014 estimate, the 2014 ART need is 542, 121 for adults and 178,500 for children under 15 years of age. Decisions concerning initiation and/or shifting of antiretroviral therapy (ART) are guided by monitoring the laboratory parameters of plasma HIV RNA (viral load) and CD4+ T cell count in addition to the patient’s overall clinical status. Monitoring clinical and diagnostic progression of patients on anti-retroviral treatment (ART) is important to examine responses to the treatment and for clinical decision-making. Decisions concerning initiation and/or shifting of antiretroviral therapy (ART) are guided by monitoring the laboratory parameters of plasma HIV RNA (viral load) and CD4+ T cell count in addition to the patient’s over all clinical response. The objective of this study was to assess factors predicting suboptimal CD4 cell recovery during first six months of ART
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