Survival, CD4 T lymphocyte count recovery and immune reconstitution pattern during the first-line combination antiretroviral therapy in patients with HIV-1 infection in Mongolia.

Solongo Bayarsaikhan,Davaalkham Jagdagsuren,Tsogtsaikhan Sandag,Batbaatar Gunchin,Wen-Chi Chou

doi:10.1371/journal.pone.0247929

Abstract

Mongolia has a low incidence of human immunodeficiency virus (HIV) infection, with 281 cases reported at the end of 2019 and an estimated incidence rate of <0.01 cases per 1000 population.However, no study has analyzed the association between antiretroviral therapy (ART) outcomes and pretreatment characteristics of patients with HIV/acquired immunodeficiency syndrome (AIDS) in Mongolia. This retrospective study aimed to determine the survival, CD4 T cell recovery, and immune reconstitution pattern during ART in HIV patients and to determine baseline patient characteristics associated with ART outcomes. Based on three different World Health Organization (WHO) guidelines, we analyzed the 3-year observation data of 166 patients with HIV/AIDS who received treatment between 2010 and 2017. An increase of >50 cells/μL indicated CD4 T cell count recovery, and a cell count of ≥500 cells/μL in patients with a baseline cell count of <500 cells/μL indicated immune reconstitution. In this study, the 3- and 1-year mortality rates were 5.4% (survival rate: 94.6%) and 3.6%, respectively. A total of 83% of deaths that occurred in the observation time occurred within the first 3 months. The CD4 T cell count recovery rates at 3, 12, and 36 months were 62.7%, 80.7%, and 89.2%, respectively. The CD4 T cell count increased to >500 cells/μL in 95 of 145 (65.5%) patients with a baseline cell count of <500 cells/μL after 36 months of ART. The baseline CD4 T cell count was found to be a sensitive indicator for immune reconstitution. An advanced pretreatment clinical stage of HIV infection (as classified by the WHO classification), a low CD4 T cell count in the peripheral blood, and a high viral load before the initiation of the first-line ART accurately predicted survival, CD4 T cell count recovery, and immune reconstitution in Mongolian patients with HIV/AIDS.

Highlights

The human immunodeficiency virus (HIV) is a lentivirus a subgroup of retrovirus that causes HIV infection and over time acquired immunodeficiency syndrome (AIDS) [1, 2].Mongolia is a low incidence country for HIV infection with 281 cases reported in end of 2019 and estimated rate of less than 0.01 cases per 1000 population [3, 4]
By the end of 2019 year 257 off total 281 confirmed HIV/AIDS cases in the country since 1992 were treated with one 6 different combination regimens of antiretroviral therapy (ART). In this retrospective study was analyzed data of 3 year (36 months) observation of 166 HIV/ AIDS patients treated from November 2010 to November 2017 according to 3 different guidelines recommended by the World Health Organization (WHO guidelines) [26,27,28]
Survival rate of the HIV-1 infected patients in the end point of observation or in the 36th months of antiretroviral therapy in accordance to baseline characteristics defined before initiation of the therapy and shown in the Table 2 were analyzed (Table 4). Some baseline characteristics such as advanced disease stage, low count of peripheral blood CD4 T cells, and high replication activity before ART initiation may predict a higher risk for fatal outcomes and poor survival (Table 4)

Summary

Introduction

Mongolia is a low incidence country for HIV infection with 281 cases reported in end of 2019 and estimated rate of less than 0.01 cases per 1000 population [3, 4]. Despite the low prevalence of HIV infection in the general population in the past two decades, the number of reported cases is growing exponentially [5]. Control of sexually transmitted infections (STIs) and preventing HIV epidemic has been a priority for the Government of Mongolia for many years and commitment has been shown in many ways. Since 1992, when was detected first case of HIV infection the HIV spread among population in the country may was sporadic until 2002 with total 3 cases, but period of 2002–2012 characterized with dramatic increase of new cases (from 10 new HIV cases in 2002 to 90 in 2012) followed with gradual decrease (30 new cases in 2017) [5]

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Results

Discussion

Conclusion