Trends of Immuno-virological Response Among HIV-Infected Patients Receiving Highly Active Anti-retroviral Therapy at Hawassa, Southern Ethiopia

Abstract

Abstract:Background: Immunological and virological response evaluation is one of a critical tool for assessing treatment outcome, regimen change and patient's management. However, data concerning any change in immunological and virological response in HIV infected patients using anti-retroviral treatment (ART) is scarce in Ethiopia. Method: This retrospective cohort study was conducted from April 2010-September 2013 at ART clinic of Hawassa University referral hospital. A total of 86 HIV-infected patients receiving Tenofovir, Stavudine and Zidovudine based regimen with either of Efavirenz or Nevirapine during ART initiation. Lamivudine is common for all. Adequate immune-virological response for most patients under treatment is defined as an increase in CD4 cells of 50-150/µl per year and viral load (VL) drops to undetectable level (<150 copies/ml) after ≥ 6 months of ART. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 20. Results: mean CD4+ cells count shows significant increment at 6, 12, 18 and 24 months after ART treatment among patients having VL <5 (log10) compared to those VL ≥5 (p=0.04; 0.002; < 0.0001; 0.001) respectively. Female have insignificantly better Mean CD4+ cells throughout 24 months. Also patients over 50 years of age do show an immune response after ART initiation. But, in relative to younger patients, their CD4 cells recovery is insignificantly sluggish. CD4+ cells and body weight of concordant positive responders show significant rising trend at 6, 12, 18, 24 months when compared to discordant responders + concordant non-responders (0.003 vs. 0.05; <0.0001 vs. 0.04; 0.001 vs.0.008; 0.001 vs.0.03) respectively. Moreover logistic regression models were applied and significant factors associated with discordant immuno-virological response were patient's body weight (AOR=0.14; 95% CI: 0.03-0.7; p=0.02) and residence (AOR=20.3; 95% CI: 2.2-188; p=0.008). Conclusion: Immunovirological response evaluation is a critical tool for assessing treatment outcome, regimen change and patient's management and the response trend decision should include both CD4+ cells and viral load results concurrently.

Detectable Virological Load and Associated Factors among People Living with HIV on Antiretroviral Treatment: A Retrospective Study

“…Some authors highlighted variations in the trend of the immunovirological response in relation to the duration of therapy. They found that concordant positive responders comprised 60.5% of the subjects at 6 months of treatment, and this value was increased to 62.8% at 12 months, whereas the percentage of concordant negative responders decreased from 9.3% to 8.1% [38]. Similarly, in a recent study, the duration of therapy ≤ 6 years was associated with immunological failure, and it was two times more likely to cause failure than a duration of follow-up on HAART of >6 years [22].…”

Recent advances in HIV diagnostics: Point-of-care CD4+ T-cell count & viral load assays

“…Nonetheless, the CD4 + T-cell count continues to be an invaluable tool for guiding the treatment of OIs in remote clinical settings with constrained availability of PVL monitoring, particularly amongst individuals with advanced HIV disease manifestations 10 . Furthermore, with immunological non-responder cases being reported to be >30 per cent among PLH, the concurrent use of both PVL and CD4 + T-cell count is warranted for their effective clinical management 11 12 .…”