Predictors of Change in CD4 Lymphocyte Count and Weight among HIV Infected Patients on Anti-Retroviral Treatment in Ethiopia: A Retrospective Longitudinal Study

Abstract

BackgroundAntiretroviral treatment (ART) has been introduced in Ethiopia a decade ago and continues to be scaled up. However, there is dearth of literature on the impact of ART on changes in CD4 lymphocyte count and weight among patients on treatment.ObjectiveTo determine the predictors of change in CD4 lymphocyte count and weight among HIV/AIDS infected patients taking antiretroviral treatment in eastern Ethiopia.MethodsA retrospective cohort study was conducted among HIV/AIDS patients taking ART from 2005 to 2010. A sample of 1540 HIV infected adult patients who started antiretroviral therapy in hospitals located in eastern Ethiopia were included in the study. The primary outcomes of interest were changes in CD4 count and weight. Descriptive statistics and multivariable regression analyses were performed to examine the outcomes among the cohort.ResultsBoth the median CD4 lymphocyte counts and weight showed improvements in the follow up periods. The multivariate analysis shows that the duration of ART was an important predictor of improvements in CD4 lymphocyte count (beta 7.91; 95% CI 7.48–8.34; p 0.000) and weight (beta 0.15; 95% CI 0.13–0.18; p 0.000). Advanced WHO clinical stage, lower baseline CD4 cell count, and baseline hemoglobin levels were factors associated with decline in weight. Actively working patients had higher CD4 lymphocyte count and weight compared to those that were ambulatory (p<0.05).ConclusionWe detected a substantial increment in weight and CD4 lymphocyte count among the patients who were taking ART in eastern Ethiopia. Patients who are of older age, with low initial CD4 lymphocyte count, late stage of the WHO clinical stages and lower hemoglobin level may need special attention. The reasons for the improved findings on CD4 count and weight throughout the five years of follow up merit further investigation.

Evolution of CD4 Cell Counts over Time for HIV/AIDS Patients on Antiretroviral Therapy (ART) In Mildmay Uganda

“…This study was in agreement with the studies of Reda et al (2013) and that of Adams and Luguterah (2013), in showing the benefit of early treatment. A higher baseline CD4 cell count would result in a better rate of recovery of patients on ART.…”

“…This study showed (for the Age≥15 years dataset) that the age of patients did not have any significant effect on the evolution in contrast to the studies of Adams and Luguterah (2013) and that of Reda et al (2013). This could be explained by the relatively young nature of the patients considered with median age (IQR) = 34 (28-40).…”

“…This result differs from that of Adams and Luguterah (2013) who described the evolution as a logarithmic function of time. It also differs from the result of Reda et al (2013) who used a linear function of time to describe the evolution.…”

“…Picat et al (2013), use nonlinear mixed-effects models, and conclude that higher long-term CD4 counts were predicted for children starting ART younger, and with higher CD4 counts. Reda et al (2013) use mixed models regression and report a substantial increment in weight and CD4 lymphocyte count among the patients who were taking ART in eastern Ethiopia.…”

Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4&lt;sup&gt;+&lt;/sup&gt; T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents

“…The decision to initiate ART in adults and adolescents relies on clinical and immunological assessment [5], WHO emphasizes the importance of using clinical parameters in deciding when to initiate ART, however it is recognized that the value of clinical staging in decision making of when to initiate and monitor ART is improved by additional information provided by baseline and subsequent (longitudinal) CD4 + T-lymphocyte cell count. CD4 + cell count criteria for ART initiation in adults and adolescents for low and middle-income countries according to WHO 2013 guidelines of 200 -350 cells/mm 3 is used and <200 cells/mm 3 are also initiated on ART.…”