CD4 Cell Count Trends after Commencement of Antiretroviral Therapy among HIV-Infected Patients in Tigray, Northern Ethiopia: A Retrospective Cross-Sectional Study

Abstract

BackgroundThe rate and extent of CD4 cell recovery varies widely among HIV-infected patients with different baseline CD4 cell count strata. The objective of the study was to assess trends in CD4 cell counts in HIV-infected patients after initiation of antiretroviral therapy in Tigray, Northern Ethiopia.MethodsA retrospective cross-sectional study was conducted by reviewing medical records of HIV patients who received antiretroviral treatment at twenty health centers in Tigray region during 2008–2012. Multi-stage cluster sampling technique was employed to collect data, and the data were analyzed using SPSS version 20.0 software.ResultsThe median change from baseline to the most recent CD4 cell count was +292 cells/μl. By 5 years, the overall median (inter-quartile range, IQR) CD4 cell count was 444(263-557) cells/μl while the median (IQR) CD4 cell count was 342(246-580) cells/μl among patients with baseline CD4 cell counts ≤200 cells/μl, 500(241-557) cells/μl among those with baseline CD4 cell counts of 201–350 cells/μl, and 652(537-767) cells/μl among those with baseline CD4 cell counts >350 cells/μl. Higher baseline CD4 cell counts and being male were independently associated with the risk of immunological non-response at 12 months. Furthermore, it was also investigated that these factors were significant predictors of subsequent CD4 cell recovery.ConclusionsPatients with higher baseline CD4 cell stratum returned to normal CD4 Cell counts though they had an increased risk of immunological non-response at 12 months compared to those with the least baseline CD4 cell stratum. The findings suggest that consideration be given to initiation of HAART at a CD4 cell count >350 cells/μl to achieve better immune recovery, and to HIV-infected male patients to improve their health seeking behavior.

Pattern and predictors of cluster of differentiation 4 (CD4) cell count recovery among cohorts of human immunodeficiency virus (HIV)-infected patients on antiretroviral therapy in Hawassa University Referral Hospital

“…There was little subsequent change in median CD 4 cell count indicating that immune recovery was optimally achieved in the earlier phases of treatment. The study observations corroborate similar studies that revealed that the most rapid and significant recovery of CD 4 cell count occurs during the first six months of treatment (Boulassel et al, 2012;Wright et al, 2011;Asfaw et al, 2015;Bennett et al, 2002). A prospective study of South African patients revealed recovery is most rapid during the first 16 weeks months of treatment (Lawn et al, 2006).…”

“…Similar variation was observed in all subpopulations of similarly small sample size. A high proportion of patients exhibited immunologic non-response (an increase of ≤50 cells/μl) at 12 months of treatment (19.3%), a proportion similar to that observed in a study conducted in Northern Ethiopia (22.7%) (Asfaw et al, 2015). Multivariate logistic regression revealed CD 4 cell count recovery was associated with baseline CD 4 cell count.…”

Comparison of Zidovudine Combination and Tenofovir Combination on the Effectiveness of Therapy and Side Effects in Hiv/Aids Patients in Rsal Mintohardjo

“…Similar to the Mintohardjo RSAL study conducted at Tigray found a significant increase and a lower risk of immunological failure in patients with a nadir CD4+ ≤ 200 cells/mm 3 when compared with patients with a higher nadir CD4+ cell count [18]. The other study also suggests that patients with very low CD4+ counts at the start of therapy, and a viral load greater than 105 log10 copies/ml, had an 11-fold increase in CD4+ cell count compared to patients with a higher initial CD4+ cell count [19].…”

Antiretroviral changes during the first year of therapy

“…6,16,20 This situation occurs due to late onset of HAART in immunocompromised patients, so that initially low levels of LTCD 4 are important predictors of the suboptimal recovery response of LTCD 4 . 23,24 Effectiveness of HAART on the decrease in VL from the start of treatment (2 to 4 months) was evidenced, with the majority of patients reaching undetectable levels between the fifth and eighth month. Patients who started treatment with VL greater than 1,000 copies/mL had partial viral suppression, since they did not reach undetectable VL six months after starting treatment.…”