Abstract
BackgroundMany HIV-infected patients only access health care once they have developed advanced symptomatic disease resulting from AIDS Defining Conditions (ADCs). We carried out a study to establish the effect of ADCs on immunological recovery among patients initiated on antiretroviral therapy (ART).MethodsA retrospective cohort of 427 HIV-1 patients who were initiated on ART between January 2002 and December 2006 was studied. Data on ADCs was retrieved from Joint Clinical Research Centre (JCRC) data base and backed up by chart reviews. We employed Kaplan-Meier survival curves to estimate median time to 50 CD4 cells/μl from the baseline value to indicate a good immunological recovery process. Cox proportional hazard models were used at multivariate analysis.ResultsThe median time to gaining 50 CD4 cells/μl from the baseline value after ART initiation was longer in the ADC (9.3 months) compared to the non-ADC group (6.9 months) (log rank test, p = 0.027). At multivariate analysis after adjusting for age, sex, baseline CD4 count, baseline HIV viral load, total lymphocyte count and adherence level, factors that shortened the median time to immunological recovery after ART initiation were belonging to the non-ADC group (HR = 1.31; 95% CI: 1.03–1.28, p = 0.028), adherence to ART of ≥ 95% (HR = 2.22; 95% CI: 1.57–3.15, p = 0.001) and a total lymphocyte count ≥ 1200 cells/mm3 (HR = 1.84; 95% CI: 1.22–2.78, p = 0.003). A low baseline CD4 count of ≤ 200 cells/μl (HR = 0.52; 95% CI: 0.37–0.77, p = 0.001) was associated with a longer time to immunological recovery. There was no interaction between low CD4 counts and ADC group.ConclusionPatients with ADCs take longer to regain their CD4 counts due to the defect in the immune system. This may prolong their risk of morbidity and mortality.
Highlights
During 2005, the World Health Organization (WHO) had estimated that there were over 1.3 million people receiving anti retroviral therapy (ART) in low and middleincome countries, representing 20% of 6.5 million estimated to need it [1]
This number excludes patients who are currently enrolled in ongoing clinical trials and patients who were monitored by physicians outside the Joint Clinical Research Centre (JCRC) facility but receiving antiretroviral therapy (ART) at JCRC pharmacy, whose data is stored else where
Multivariate analysis The time to attain immunological recovery decreased among patients with no AIDS Defining Conditions (ADCs), a total lymphocyte count of ≥ 1200 cells/mm3 and those with adherence to ART was equal or greater than 95%
Summary
During 2005, the World Health Organization (WHO) had estimated that there were over 1.3 million people receiving anti retroviral therapy (ART) in low and middleincome countries, representing 20% of 6.5 million estimated to need it [1]. As the number of individuals able to access treatment is increasing, one of the challenges facing ART services in sub-Saharan Africa is that many HIV-infected patients only access healthcare once they have developed advanced symptomatic disease resulting from AIDS Defining Conditions (ADCs)[4]. Advanced pre-treatment immunodeficiency has been found to be associated with diminished capacity for restoration of CD4 cell counts and CD4 cell functional responses after ART initiation. This raises the concern that many ADCs patients entering ART programmes in sub-Saharan Africa may have limited potential for immunological recovery[5,6]. We carried out a study to establish the effect of ADCs on immunological recovery among patients initiated on antiretroviral therapy (ART)
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