Long term immune recovery of adult HIV infected patients taking highly active antiretroviral therapy as measured by CD4+ T cell counts in ALERT hospital, Addis Ababa Ethiopia
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Date
2012-06
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Addis Abeba University
Abstract
BACKGROUND: More than five years have elapsed since free ART has been available
to PLWHA in Ethiopia. The Ethiopian ART guideline follows the ART recommendations
for resource limited countries forwarded by WHO in 2006. There are more than 280,000
PLWHA in Ethiopia who have ever been started with ART. The response to treatment is
followed using a six monthly determination of CD4+ T cells. However, there is scarcity
of information regarding the degree of immune recovery among PLWHA in Ethiopia
who have been on ARV since 2005.
OBJECTIVE: To assess immune recovery of adult HIV infected patients who have been
on ART from 1-6 years and factors influencing it.
METHOD: A retrospective study was conducted in ALERT hospital, Addis Ababa,
Ethiopia on adult HIV infected patients who have been taking antiretroviral therapy for
more than six months. Data was collected from pre-ART, ART and follow up formats
and analyzed using SPSS version 20 and GraphPad Prism 5.
RESULT: Among the total of 4419 reviewed medical records, 61.6% were females and
the median age for all study participants was 35 years (IQR, 29-40). The mean (95% CI)
weight at baseline was 53(SD=10.4) Kilogram; 57.7 (SD=10.3) for males and
50(SD=9.5) for females (p=0.000). The median CD4 at baseline was 135(IQR, 72-201);
120 (IQR, 62-186) for males and 144 (IQR, 79-209) for females (p=0.000). At baseline,
16.0%, 59.0%, and 25.0% participants had a CD4 cell/ µl of ≤50, 51-200 and ≥201,
respectively. Among the total OIs and co-morbidities, Herpes zoster was the most
frequently observed one (20.7%). There was a dramatic increment of CD4 cells/ µl across
all age groups during the first six months of follow up period. Particularly, the age group
15-24 years had the highest (21.8 cells/µl /month) rate of CD4 cells/ µl increment. The
overall rate of increment during the 72 months follow up was 4.4 cells/µl /month.
Patients who start antiretroviral treatment with ≤50 cells/ µl had the highest rate (21.2
cells/µl /month) during the first six month of treatment. At the end of the 72 months, the
median CD4 difference from the baseline was 314 cells/µl and the overall mean weight
increment was 6.2 Kg.
CONCLUSION: The study has shown CD4 increment which is comparable with other
developed and developing countries, especially in the first 6 months. In this study,
females and younger age groups (15-24 years) have shown a better immune recovery.
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Keywords
Antiretroviral therapy; CD4 cell count; HIV infection