Trend of Cd4 Cell Count at Initiation of Highly Active Antiretroviral Therapy (Haart) in Klinik Kesihatan Seremban (Kks)

Abstract

Background: CD4 T lymphocyte (CD4) is the most important marker that has been used in the management of HIV. The CD4 cell count provides information on the overall immune function of an HIV-infected patient. There is an overwhelming evidence that early initiation of HAART, at higher CD4 cell count will lead to virological and immunological success, prevent disease progression and reduces the social and economic costs of advanced HIV-related illness. We investigated the trend of CD4 cell count at initiation of HAART among HIV patients in KKS. Materials and Method: All registered HIV patients from year 2012 to 2017 were enrolled in this study. Data was collected retrospectively from patient's data base and clinic's registry using a standardized data collection form. The data was analyzed by using SPSS version 16.0 and presented with percentages, mean and median values. We also compared the CD4 cell count at HAART initiation with recommendation in Malaysian Consensus Guideline on Antiretroviral. Additionally, we investigated the possible factors that lead to late initiation of HAART. Results: Mean and median values of CD4 cell count at initiation of HAART were 411.03 cell/mm 3 and 314 cell/mm 3 respectively. There was an increasing trend of median CD4 cell count from 2014 until 2016 and in reducing trend in 2017. From 41 patients who were initiated on HAART, 68.3% (n=28) initiated HAART early while 31.7% (n=13) had late initiation. The late initiation of HAART was primarily due to late presenters. Conclusion: CD4 cell count at initiation of HAART in KKS was found to be high. Generally the practice of initiating HAART in KKS is in compliance to the Malaysian Consensus Guideline in ART. However, a number of patients with late initiation of HAART is of concern. We recommend a strategic interventions to increase earlier detection of HIV patients and earlier start of HAART at higher CD4 cell count to prevent HIV transmission and improve mortality and morbidity.