Immunological Response Among Adult Individuals on ART Therapy Before and After Therapy Started for the Last 5 Years (2006–2010) at Zewuditu Hospital Addis Ababa, Ethiopia.
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Date
2012-07
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Addis Ababa University
Abstract
Background: HIV is isolated in 1983, human immunodeficiency Virus (HIV), the agent that causes acquired immune deficiency syndrome (AIDS), is classified as members of the lentivirus subfamily of retroviruses. There are two main types of HIV: HIV type 1(HIV-1): the most prevalent throughout the world. HIV type 2 (HIV-2) is prevalent in West Africa. They both cause ADIS and the routes of transmission are the same. However, HIV-2 causes AIDS much more slowly than HIV-1. Although HAART is known to profoundly suppress viral replication, it increases CD4 cell count and delays disease progression and death; patients on Highly Active Antiretroviral Therapy (HAART) commonly suffer from side effects of the drug. Each antiretroviral drug is associated with specific adverse effects. Several studies in developed countries have shown that AZT alone and AZT based HAART regimen is associated with significant reduction of hemoglobin (Hb) level and neutrophil number. The impact of its immunological recovery rate / including at what time to start on Treatment is not well known in Ethiopian context. Hence this research was conducted to determine its immunological responses at different interval and at the start.
Objective: The aim of this retrospective cohort study was to describe immunological response among HIV-infected individuals receiving highly active antiretroviral therapy (HAART) with long-term follow-up.
Method: A Cohort retrospective study design was conducted to assess immunological (the CD 4+ recovery) among HIV-infected individuals receiving highly active antiretroviral therapy (HAART) with long-term follow-up. Antiretroviral-naive patients with symptomatic HIV disease at baseline (before ART) and after 6 and 9 and 12 months of ART will be collected from records and after start ART in Zewditu Hospital, Addis Ababa, Ethiopia.
Result: A total of 887 HIV positive patients in this research; Out of these 472 (53.2%) were female and 415 (46.8%) male patients. The ratio of male to females was almost 1:2. None of them have any opportunistic infection during the time of follow up. The mean age of the study group was 36.76 (17-76). The mean baseline CD4 was 81.40; the mean CD4 count at the ,9thand 12th
month was 191.65, 284 and 331 respectively. There was a good immune
recovery at the 6th month of therapy from the baseline mean CD 4+ T cell count of 81 cells /l to 191.65 cells /l, which was statically highly significant (p<0.0001). This first remarkable rise was continued in the achieving in the mean CD4+ count of 284 cells/l at the 9 month of visit. Followed by relatively steady lower increase and approaching stable CD4+ T cell count and 12th months of visit.
Conclusion and Recommendations In conclusion, in our study, although good CD4 cells recovery in response to ART was documented in more than 81% of follow-up cases, HIV positive patients were enrolled in ART program at decreased CD4 cells levels. As there is poor recovery of CD4 cell when the start >200 than when they start ART at CD4 count >200 CD4 cell. Therefore, interventions need to be designed to promote early HIV testing and early enrollment of HIV infected individuals into ART services. ART has considerably improved the immune recovery. We strongly recommend underline the need of anti-retroviral therapy in HIV infected patients for immune reconstitution should be started as early as possible. The differential recovery rate between those with base line CD4+ T cell count below 50cells/l and above 500cells/l needs further investigation.
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Keywords
Immunological response, CD 4 HIV, Highly Active Antiretroviral Therapy Zidovudine