Pattern and predictors of immunologic recovery in HIV infected patients

Kwofie, Theophilus B.; Owusu, Michael; Mutocheluh, Mohamed; Nguah, Samuel Blay; Obeng-Baah, Joseph; Hanson, Charlotte; Dompreh, Albert

doi:10.1186/s13104-015-1406-3

Cited by 9 publications

(9 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This supports the most recent WHO guidelines, which advocates the initiation of ART for all HIV infected individuals regardless of CD4 count [1]. Similar to other published studies [14,33,35,36], we have shown that proportionally, immunological recovery was highest in patients who had begun treatment with a ‘low’ (<100 cells/ mm 3 ) count at baseline. However, despite showing the highest relative increase in CD4 recovery, patients in the ‘low’ group achieved lower CD4 peaks than those with higher baseline groups.…”

Section: Discussionsupporting

confidence: 91%

HIV treatment outcomes following antiretroviral therapy initiation and monitoring: A workplace program in Papua, Indonesia

Limmade

Fransisca²,

Rodríguez-Fernández³

et al. 2019

PLoS ONE

View full text Add to dashboard Cite

Background Papua Province, Indonesia is experiencing an on-going epidemic of Human Immunodeficiency Virus (HIV) infection, with an estimated 9-fold greater prevalence than the overall national rate. This study reviewed the treatment outcomes of an HIV-infected cohort on Antiretroviral Therapy (ART) and the predictors in terms of immunological recovery and virological response. Methods ART-naïve individuals in a workplace HIV program in southern Papua were retrospectively analyzed. Patients were assessed at 6, 12 and 36 months after ART initiation for treatment outcomes, and risk factors for virological suppression (viral load (VL) <1,000 copies/ml), poor immune response (CD4 <200 cells/mm 3 ) and immunological failure (CD4 <100 cells/ mm 3 ) after at least 6 months on ART, using a longitudinal Generalized Estimating Equations multivariate model. Results Assessment of 105 patients were included in the final analysis with a median age of 34 years, 88% male, median baseline CD4 236 cells/ mm 3 , and VL 179,000 copies/ml. There were 74, 73, and 39 patients at 6, 12, and 36 months follow-up, respectively, with 5 deaths over the entire period. For the three observation periods, 68, 80, and 75% of patents achieved virological suppression, poor immune responders decreased from 15, 16 to 10%, whilst 15, 16, 10% met the immunological failure criteria, respectively. Using multivariate analysis, the independent predictor for viral suppression at 12 and 36 months was ≥1 log decrease in VL at 6 months (OR 19.25, p<0.001). Higher baseline CD4 was significantly correlated with better immunological outcomes, and lower likelihood of experiencing immunological failure (p <0.001). Conclusion Virological response at six months after beginning ART is the strongest predictor of viral suppression at 12 and 36 months, and may help in identifying patients needing additional adherence therapy support. Higher baseline CD4 positively affects the immunological outcomes of patients. The findings indicate HIV control programs should prioritize the availability of VL testing and begin ART regardless of CD4 counts in infected patients.

show abstract

Section: Discussionsupporting

confidence: 91%

HIV treatment outcomes following antiretroviral therapy initiation and monitoring: A workplace program in Papua, Indonesia

Limmade

Fransisca²,

Rodríguez-Fernández³

et al. 2019

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Consistent findings were reported from Tanzania (AOR = 4:1, (1.6-10.4), P = 0:003) [39], Uganda [41], and Bahir Dar, Ethiopia (AOR = 1:90, 95% CI: 1.41-2.56, P = 0:001) [24]. Contrasting finding from our study was reported from Asella, Ethiopia [42] that indicated HAART regimen variability was not significantly associated Journal of Immunology Research with recovery of CD4 counts and viral load failure, Addis Ababa, Ethiopia [43] and in Uganda study [44].…”

Section: Discussioncontrasting

confidence: 69%

Long-Term Immunological and Virological Outcomes in Children Receiving Highly Active Antiretroviral Therapy at Hawassa University College of Medicine and Health Sciences, Southern Ethiopia

Fenta

Wube

Nuru

2021

Journal of Immunology Research

View full text Add to dashboard Cite

Purpose. To determine immunological and virological failure and associated factors among children infected with human immunodeficiency virus receiving antiretroviral treatments at Hawassa University Hospital, Southern Ethiopia. Methods. A hospital-based cross-sectional study was conducted among 273 HIV-infected children from July 1 to December 1, 2019. Data were collected using a structured questionnaire and review of patient records. Blood samples for viral load and CD4 count were collected. Data were analyzed using SPSS version 20. Significance group comparison was done by the Kaplan-Meier log-rank test. The Cox proportional hazard model was used to select significant factors of the variability between groups. Results. A total of 273 children, between the age ranges of 1 to 14 years, were included. Of these, 139 (50.9%) and 134 (49.1%) were males and females, respectively. Children from the rural area were almost five times more vulnerable for virological and immunological failure than those children from the urban area ( AOR = 4.912 , (1.276-8.815), P = 0.032 ). The overall viral load suppression was 196 (71.8%) with a good adherence of 226 (82.9%). Nonsuppressed HIV viral load was found to be 77 (28.2%) which had two times more viral load copies ( AOR = 2.01 , (1.21–2.66), P = 0.001 ) when compared to those who had suppressed viral load copies. The proportions of children who had immunological nonresponse were 45.6% (21 out of 46), 30.4% (14 out of 46), and 23.9% (11 out of 46) among children with baseline CD4 of <200, 201-500, and >500 cells/μl, respectively. Unimproved outcomes among females were noted for immunological and virological failure in this study ( AOR = 1.901 , (1.038-3.481), P = 0.038 ). Conclusion. In conclusion, the highly active antiretroviral treatment appeared highly effective in terms of immunological and virological long-term outcomes. However, viral suppression (71.8%) in our study was far apart from the UNAIDS target of 90% in 2020. For that reason, strengthening adherence counseling and early initiation of HAART is important.

show abstract

“…Although this is the first ever national level analysis of CD4 count recovery data, this analysis confirms what smaller cohorts of up to 90 000 individuals from South Africa and other sub Saharan African settings have demonstrated. These studies demonstrated that i) the CD4 count at the start of ART was the strongest predictor of CD4 count recovery, [29] ii) CD4 recovery was rapid early in the course of ART but stabilised around 12 months post ART initiation, [30] and iii) CD4 count recovery is slower in males compared to females and in older individuals compared to younger individuals. [7,8,31,32] However, the comparison of CD4 count recovery by province and calendar year is new.…”

Section: Discussionmentioning

confidence: 99%

CD4 count recovery and associated factors among individuals enrolled in the South African antiretroviral therapy programme: An analysis of national laboratory based data

et al. 2019

View full text Add to dashboard Cite

Background We describe CD4 count recovery among HIV positive individuals who initiated antiretroviral therapy (ART) with and without severe immune suppression using complete laboratory data from South Africa’s national HIV treatment programme between 2010 and 2014 and discuss implications for CD4 count monitoring. Methods Retrospective analysis of routinely collected laboratory data from South Africa’s National Health Laboratory Service (NHLS). A probabilistic record linkage algorithm was used to create a cohort of HIV positive individuals who initiated ART between 2010 and 2014 based on timing of CD4 count and viral load measurements. A CD4 count < 50 copies/μl at ART initiation was considered severe immunosuppression. A multivariable piecewise mixed-effects linear regression model adjusting for age, gender, year of starting ART, viral suppression in follow up and province was used to predict CD4 counts during follow up. Results 1,070,900 individuals had evidence of starting ART during 2010–2014 and met the criteria for inclusion in the cohort -46.6% starting ART with CD4 < 200 cells/μl and 10.1% with CD4 < 50 cells/ μl. For individuals with CD4 counts < 200 cells/μl, predicted CD4 counts > 200 cells/μl, >350 cells/μl and >500 cells/μl corresponded with mean follow up durations of 1.5 years (standard deviation [s.d] 1.1), 1.9years (s.d 1.2) and 2.1 years (s.d 1.3 years). For those with CD4 counts < 50 cells/μl, predicted CD4 count above these threshold corresponded with mean follow up durations of 2.5 years (s.d 0.9 years), 4.4 years (s.d 0.4 years) and 5.0 years (s.d 0.1years) for recovery to the same thresholds. CD4 count recovery varied mostly with duration on ART, CD4 count at the start of ART and gender. Conclusion For individuals starting with ART with severe immunosuppression, CD4 recovery to 200cells/μl did not occur or took longer than 12 month for significant proportions. CD4 monitoring and interventions recommended for advanced HIV disease should continue until full recovery.

show abstract

Pattern and predictors of immunologic recovery in HIV infected patients

Cited by 9 publications

References 25 publications

HIV treatment outcomes following antiretroviral therapy initiation and monitoring: A workplace program in Papua, Indonesia

HIV treatment outcomes following antiretroviral therapy initiation and monitoring: A workplace program in Papua, Indonesia

Long-Term Immunological and Virological Outcomes in Children Receiving Highly Active Antiretroviral Therapy at Hawassa University College of Medicine and Health Sciences, Southern Ethiopia

CD4 count recovery and associated factors among individuals enrolled in the South African antiretroviral therapy programme: An analysis of national laboratory based data

Contact Info

Product

Resources

About