Effects of Gender and Baseline CD4 Count on Post-Treatment CD4 Count Recovery and Outcomes in Patients with Advanced HIV Disease: A Retrospective Cohort Study

Kouamou, Vinie; Gundidza, Patricia; Ndhlovu, Chiratidzo E.; Makadzange, Tariro; Chivige, Exavior; Makaha, Edward; Mwarumba, Taddy; Ross, Christine; Vallabhaneni, Snighdha; Balachandra, Shirish

doi:10.1089/aid.2022.0117

Cited by 1 publication

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“…A multicentric cohort analysis in SSA has previously showed that men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women [5]. We recently showed in a retrospective study that male participants were at increased risk of poor immunological response, highlighting the vulnerability of this sex in better clinical outcomes [6]. However, limited and large prospective cohort studies in resource limited settings have highlighted various factors associated with CD4 þ cell count recovery among people with severe AHD receiving care in public health clinics based on sex difference.…”

Section: Introductionmentioning

confidence: 93%

Factors associated with CD4 cell count recovery among males and females with advanced HIV disease

Kouamou,

Gundidza,

Ndhlovu

et al. 2023

Aids

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Objective: HIV/AIDS mortality remains significantly high in Sub-Saharan Africa, mostly driven by opportunistic infections and advanced HIV disease (AHD). This study aimed to assess CD4 cell count recovery following ART initiation and factors associated with immune reconstitution. Methods: We conducted a prospective cohort study between 2015-2016. HIV-infected adults (≥18 years) with AHD (CD4 cell count ≤100 cells/mm3) receiving care at 20 outpatient HIV treatment facilities in Harare, Zimbabwe were enrolled. CD4 cell count recovery (CD4 cell count >200 cells/mm3) was assessed following 12-month ART initiation and factors associated with immune reconstitution were investigated using Logistic regression analysis. All statistical analyses were performed on SPSS v23. Results: 1320 participants were enrolled and 56.4% were males. The median (IQR) age was 37 (32–43) years. Tuberculosis was seen in 16.0%. Of the 739 participants that had CD4 cell count at 12 months, CD4 cell count recovery above 200 cells/mm3 was observed in 163 (22.1%) participants. Median (IQR) CD4 cell count at 12-months increased to 127 (75–190) cells/mm3 from 31 (14 – 55) at baseline. Factors associated with CD4 cell count recovery were younger age at baseline (OR≥40/<40 = 0.58, 95%CI: 0.40–0.85, P = 0.005), sex (ORfemale/male = 2.07, 95%CI:1.44–2.99,P < 0.0001) and baseline CD4 cell count (OR≥50/<50 = 1.60, 95%CI:1.10–2.33,P = 0.013). Conclusion: A significant proportion (77.9%) of patients seeking care with AHD in a resource limited setting failed to recover a CD4 cell count >200 cells/mm3. Male sex, older age and low CD4 cell count at ART initiation were factors associated with poor immune reconstitution. Better differentiated care deliveries targeting this vulnerable population are critical for improving clinical outcomes and quality of life of the patients.

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Section: Introductionmentioning

confidence: 93%