<p>Immunological Response During HAART and Determinants of Current CD4⁺ T-Cell Count Among HIV/AIDS Patients Attending University of Gondar Referral Hospital, Northwest Ethiopia</p>

Abstract

Purpose After the initiation of highly active antiretroviral therapy (HAART), successful HAART is characterized by an increase in the CD4 + count. Several factors affect the CD4 + T-cell count. This study aimed to assess the immunological response during HAART and determinants of the current CD4 + T-cell count among HIV/AIDS patients on HAART. Patients and Methods A hospital-based cross-sectional study was conducted from February 1 to April 1, 2017. A total of 423 HIV/AIDS patients on HAART were enrolled using simple random sampling. Descriptive statistics, and bivariate and multiple regression analyses were conducted. Variables with p -value <0.2 in the bivariate analysis were entered in the multiple regression models. p -Values <0.05 and 95% confidence intervals were used to identify determinants of the current CD4 + T-cell count. Results The mean CD4 + T-cell count gradually increased until 8 years on HAART but declined thereafter. An increased current CD4 + T-cell count was observed among patients with an initial regimen of pediatric d4T-3TC-NVP [ β =185.5, 95% CI (8.8, 362.2)] ( p =0.040), with increased baseline CD4 + T-cell count [ β =0.468, 95% CI (0.342, 0.594)] ( p <0.0001), and with long duration on HAART [ β =18.0, 95% CI (9.9, 26.1)] ( p <0.0001), whereas a decreased level of current CD4 + T-cell count was observed among males [ β =−72.7, 95% CI (−114.5, –30.9)]) ( p <0.0001) and those with poor baseline adherence [ β =−108.9, 95% CI (−210.9, −7.0)] ( p =0.036) and viral load >1000 copies [ β =−189.2, 95% CI (−243.5, −134.9)] ( p <0.0001). Conclusion The trend in immunological response was not increased linearly throughout the HAART duration. Sex, type of initial regimen, baseline adherence, baseline CD4 + count, viral load, and duration on HAART were independent determinants of current CD4 + count. These determinants could be addressed by regular monitoring of HIV patients on HAART, and special attention should be paid to male patients.

Predictors of Current CD4+ T-Cell Count Among Women of Reproductive Age on Antiretroviral Therapy in Public Hospitals, Southwest Ethiopia

“…67,68 In the current study, baseline CD4 + T-cell count was found to be significant, where for each increment of cells/ mm 3 of blood in the baseline CD4 + T-cell count, the current CD4 + T-cell count increased. This finding is consistent with studies conducted in Felege Hiwot referral hospital, 22 University of Gondar referral hospital, 21,69 and Tigray Health Research Institute. 23 The results of the current study have some limitations.…”

“…The current CD4 + T-cell count of women of reproductive age on ART with poor adherence was less as compared with those with good adherence. Different studies conducted in China, 56 Abidjan, Côte d’Ivoire, 57 and University of Gondar Referral Hospital, northwest Ethiopia 21 , 58 revealed that adherence increased CD4 cells. Poor adherence to antiretroviral therapy (ART) may result in less effective viral suppression, poor immunological recovery, drug resistance, treatment side-effects, treatment failure, and subsequently reduced treatment options.…”

“…19,20 For instance, higher baseline CD4 + T-cell count, long duration on ART, younger age, patients from a military health care facility, good adherence, viral load suppression and early initiation of treatment contributed positively to the increment of the CD4 count. 21,22 Whereas, patients on ART regimen of 1e (TDF-3TC-EFV), 2f (AZT-3TC-ATV/r), and 2h (TDF-3TC-ATV/r), and a viral load >1000 copies were negatively associated with recent CD4 count. [21][22][23] Besides, factors like urban residency 24 and white ethnicity were associated with increased CD4 count.…”

“…21,22 Whereas, patients on ART regimen of 1e (TDF-3TC-EFV), 2f (AZT-3TC-ATV/r), and 2h (TDF-3TC-ATV/r), and a viral load >1000 copies were negatively associated with recent CD4 count. [21][22][23] Besides, factors like urban residency 24 and white ethnicity were associated with increased CD4 count. 25 Whereas old age, lower CD4 count at baseline, 26 severe clinical-stage, tuberculosis (TB) coinfection, 27 poor nutritional status, pregnancy, stress, smoking status, and drug use have been investigated as predictors of low CD4 count.…”

<p>Magnitude and Associated Factors of Pulmonary Tuberculosis Among HIV/AIDS Patients Attending Antiretroviral Therapy Clinic at Debre Tabor Specialized Hospital, Northwest Ethiopia, 2019</p>

“… 33 On the other hand, for viral load testing, the plasma was prepared for transportation on dry ice to the Amhara Public Health Institute (APHI) and processed following the standard protocol and Biosafety precautions as described elsewhere. 34–36 At APHI, viral load was performed by using a quantitative real-time polymerase chain reaction (QRT-PCR) HIV-1 assay with the COBAS ® instrument (Roche, Homburg, Germany).…”