Impact of Viral Load Suppression on CD4 + T-cell Count and BMI Following Combine Antiretroviral Therapy (cART) in HIV-1 Infected Individuals: Preliminary Findings in a Resource Poor Setting

Abstract

Background: Immunological CD4+ T cell gain is representative of an effective response to combined antiretroviral therapy (cART) in HIV-infected persons. Nevertheless, baseline clinical and socio-demographic factors are significant moderators of this response. Objects: This study investigates the impact of viral suppression on immune reconstitution and body mass index (BMI) following ART initiation in Zaria, a resource-poor subpopulation in Northwestern Nigeria. Methods: A hospital-based prospective study was conducted among 44 cART-naïve HIV-positive individuals. BMI, CD4 counts and viral load were measured using standard methods at baseline and six months after initiation of cART. Results: There was no significant difference in the CD4+ T-cell count at baseline and 6 months on cART along the different categories (C: < 200 cells/mm3, B: 200-499 cell/mm3, A: >500 cell/mm3). However, ~90% of subjects in category C had immunological failure 6 months on cART. The number of subjects with viral copies < 1000/ml at baseline was 7(16%), while at 6 months on cART the number increased to 35(80%), P<0.05. Viral suppression (VL copies <1000/ml) was significantly correlated with immune recovery (CD4 count > 200 cell/mm3) in obese individuals (P<0.02). There was a significant association between subjects with CD4+ count < 200 cells/mm3 after 6 months on ART and having a baseline VL copies of <1000/ml and low BMI (aOR 2.2 and 2.4 respectively, p≤0.05). Conclusion: Findings from this study suggest a high prevalence of paradoxical VL suppression but not immune CD4 gain in the studied subjects following cART. Larger studies are needed to corroborate these findings.

Prevalence of Cytopenia and its Correlation with Immunosuppression in Naïve HIV-1 Infected Patients Initiating First-Line Antiretroviral Therapy: A Pilot Study

“…In 2018, the WHO recommended transitioning to DTG-based antiretroviral therapy due to compelling evidence showcasing its rapid reduction of HIV viremia. However, this rapid viral reduction itself poses an independent risk factor for the development of immune reconstitution inflammatory syndrome (IRIS), characterized by paradoxical inadequate immune function recovery [ 34 35 ], as also suggested in our previous reports [ 25 26 ]. Furthermore, DTG triggers cell shrinkage and phospholipid scrambling of the erythrocyte cell membrane, a phenomenon known as eryptosis [ 34 ].…”

“…While detailed demographic and clinical characteristics of the study population have been previously published [ 25 ], a concise summary is presented in Table 1 for reference. Among treatment-naive HIV-positive participants, 61% exhibited absolute CD4+ T cell counts <200 cells/mm 3 , with corresponding rates of anemia, leucopenia, and thrombocytopenia at 66%, 23%, and 11%, respectively.…”

“…Baseline haematological and CD4+ T lymphocyte counts were assessed, followed by evaluations at 24 weeks post-commencement of combined antiretroviral therapy (cART24). Detailed socio-demographic characteristics and HIV diagnosis information have been previously documented in our earlier studies [ 25 26 ]. All participants received dolutegravir/lamivudine/tenofovir (DTG/3TC/TDF), a fixed-dose combination antiretroviral medication, in line with the 2019 WHO recommendation for first-line treatment in adults.…”

“…Haematological parameters were assessed using the Mindray 3200 Auto Haematology Analyzer (Shenzhen Mindray Bio-Medical, Shenzhen, China). The techniques employed for HIV diagnosis, viral load measurement, and CD4+ T cell count determination have been elaborated in previous publications [ 25 26 ].…”