Trends of Immuno-virological Response Among HIV-Infected Patients Receiving Highly Active Anti-retroviral Therapy at Hawassa, Southern Ethiopia

Abstract

Background: Immunological and virological response evaluation is one of a critical tool for assessing treatment outcome, regimen change and patient’s management. However, data concerning any change in immunological and virological response in HIV infected patients using anti-retroviral treatment (ART) is scarce in Ethiopia. Method: This retrospective cohort study was conducted from April 2010–September 2013 at ART clinic of Hawassa University referral hospital. A total of 86 HIV-infected patients receiving Tenofovir, Stavudine and Zidovudine based regimen with either of Efavirenz or Nevirapine during ART initiation. Lamivudine is common for all. Adequate immuno-virological response for most patients under treatment is defined as an increase in CD4 cells of 50–150/µl per year and viral load (VL) drops to undetectable level (<150 copies/ml) after ≥ 6 months of ART. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 20. Results: mean CD4+ cells count shows significant increment at 6, 12, 18 and 24 months after ART treatment among patients having VL <5 (log10) compared to those VL ≥5 (p=0.04; 0.002; < 0.0001; 0.001) respectively. Females have insignificantly better Mean CD4+ cells throughout 24 months. Also patients over 50 years of age do show an immune response after ART initiation. But, in relative to younger patients, their CD4 cells recovery is insignificantly sluggish. CD4+ cells and body weight of concordant positive responders show significant rising trend at 6, 12, 18, 24 months when compared to discordant responders + concordant non-responders, and p-value: (0.003 vs. 0.05; <0.0001 vs. 0.04; 0.001 vs.0.008; 0.001 vs.0.03) respectively. Moreover logistic regression models were applied and significant factors associated with discordant immuno-virological response were patient’s body weight (AOR=0.14; 95% CI: 0.03-0.7; p=0.02) and residence (AOR=20.3; 95% CI: 2.2-188; p=0.008). Conclusion: Immuno-virological response assessment is a critical tool for addressing treatment outcome, regimen change and patient’s management for those peoples living with HIV using ART. Therefore we recommend that treatment response decision should include both CD4+ cells count and viral load concurrently.