Immunological status and virological suppression among HIV-infected adults on highly active antiretroviral therapy

Abstract

Background: World Health Organization (WHO) recommends that viral load ([VL) is a primary tool that clinicians and researchers have used to monitor patients on antiretroviral therapy (ART), an antiviral drug against retroviruses. Whereas, CD4 cell counts can only be used to monitor clinical response to ART in the absence of VL testing service. Therefore, this study is aimed to assess the level of immunological status and virological suppression, and identify associated factors among human immunodeficiency virus ([HIV)-infected adults who were taking antiretroviral drugs of combination regimen know as highly active antiretroviral therapy (HAART). Methods: A hospital-based cross-sectional study was conducted at the University of Gondar comprehensive specialized referral hospital from February to April 2018. A total of 323 adult participants on HAART were selected using a systematic random sampling technique and enrolled into the study. Blood samples for viral load determination and CD4 cell count were collected. Binary logistic regression analysis was used to determine factors associated with immunologic status and virological suppression in HIV patients on HAART. Odds ratio with 95% CI was used to measure the strength of association. Results: Virological suppression (VL level < 1000 copies/ml) was found in 82% (95% CI 77.7, 86.1) of study participants, and it has been associated with CD4 cell count between 350 and 499 cells/mm 3 (adjusted odds ratio (AOR) = 2.56; 95% CI 1.14, 5.75) and > 499 cells/mm 3 (AOR = 7.71; 95% CI 3.48, 17.09) at VL testing and current age > 45 years old (AOR = 5.99; 95% CI 2.12, 16.91). Similarly, favorable immunological status (≥ 400 cells/mm 3 for male and ≥ 466 cells/mm 3 for female) was observed in 52.9% (95% CI 47.4, 58.8) of the study participants. Baseline CD4 cell count of > 200 cells/mm 3 , age at enrollment of 26 through 40 years old, and urban residence were significantly associated with favorable immunological status. Conclusion: Though the majority of HIV-infected adults who were on HAART had shown viral suppression, the rate of suppression was sub-optimal according to the UNAIDS 90-90-90 target to help end the AIDS pandemic by 2020. Nonetheless, the rate of immunological recovery in the study cohort was low. Hence, early initiation of HAART should be strengthened to achieve good virological suppression and immunological recovery.

Effectiveness of integrase strand transfer inhibitors in HIV‐infected treatment‐experienced individuals across Europe

“…Based on individual and public health benefits consequent to early initiation of ART, together with increased safety and tolerability of antiretroviral strategies, ART is now recommended for all PLWH [4][5][6]. Indeed, although eradication of HIV infection cannot be achieved with current ART, durable plasma HIV RNA suppression minimizes the risk of emergent drug resistance and contributes to restoring immunological function [7][8][9][10]. Due to proven efficacy, safety and ease of administration, integrase strand transfer inhibitors (INSTIs) are recommended for the treatment of HIV infection in many settings [11][12][13].…”

Long‐Term Administration of Abacavir and Etravirine Impairs Semen Quality and Alters Redox System and Bone Metabolism in Growing Male Wistar Rats

“…Antiretroviral therapy made it possible to decrease the viral load below the sensitivity limit of diagnostic tests, caused an increase in the level of CD4 lymphocytes, and reduced the incidence of opportunistic infections and the development of full-blown acquired immunodeficiency syndrome (AIDS). As a consequence, mortality in HIV patients has decreased significantly [2][3][4]. However, drug-induced side effects associated with longterm antiretroviral therapy are becoming a growing concern [2,3,5].…”

“…As a consequence, mortality in HIV patients has decreased significantly [2][3][4]. However, drug-induced side effects associated with longterm antiretroviral therapy are becoming a growing concern [2,3,5]. HIV therapy involves highly active antiretroviral therapy (HAART), meaning that patients are treated with drug combinations.…”

The Effect of appointment spacing model of care on virological suppression and associated factors among HIV positive individuals on antiretroviral therapy at public health facilities of Debre Markos town, northwest Ethiopia: Interrupted time series design.

“…Accordingly, the majority of our study participants had good adherence, and they were from urban residences, which might have access to health care facilities that might not require walking long distances to get HIV care services; this could make them to take their medication on time, which would have an impact on the control of viral replication and the improvement of immunological status [38,39].Previous studies have demonstrated that those clients who live far from healthcare facilities where services are offered had delayed healthcare-seeking behavior; this in turn leads to virologic-non suppression [40,41]. The other possible explanation could be that most of our study participants were disclosed their HIV status and had treatment supporters.…”