Predictors of Current CD4+ T-Cell Count Among Women of Reproductive Age on Antiretroviral Therapy in Public Hospitals, Southwest Ethiopia

Overview

Journal HIV AIDS (Auckl)

Publisher Dove Medical Press

Specialty Infectious Diseases

Date 2021 Jun 25

PMID 34168505

Citations 2

Authors

Alemayehu Sayih Belay

Gizachew Ayele Manaye

Kindie Mitiku Kebede

Dejene Derseh Abateneh

Affiliations

Soon will be listed here.

Abstract

Background: HIV/AIDS is one of the major global public health problems. CD4 is a glycoprotein found on the surface of different immune cells. CD4 cell counts determine the need for screening and prophylactic interventions against common opportunistic infections in those with advanced HIV disease. Thus, this study aimed to assess the predictors of current CD4 T-cell count among women of reproductive age on antiretroviral therapy in public hospitals, southwest Ethiopia.

Methods: A cross-sectional study was conducted from February to April 2018. A total of 422 participants in the three public hospitals were selected using a systematic random sampling method. Linear regression analyses were used to determine the important predictors of current CD4 T-cell count at p-values of <0.05.

Results: A total of 422 women with a median age of 37.00 years participated in this study. More than one in ten (12.8%) respondents experienced immunological failure. An increased current CD4 T-cell count was observed among patients with a tertiary level of education [ = 56.45, 95% CI (3.5, 109.4)], baseline WHO clinical stage II [ = 44.06, 95% CI (5.3, 82.9)], initial regimen of AZT+3TC+EFV [ = 167.23, 95% CI (100.4, 234.1)], with increased baseline CD4 T-cell count [ = 0.35, 95% CI (0.2, 0.5)], and with increased time duration on ART [ = 14.36, 95% CI (6.304, 22.4)]. On the other hand, the current CD4 T-cell count was lowered among patients with poor baseline adherence, opportunistic infection, and viral load of ≥1000 by 181.06 cells/mm, 101.62 cells/mm, and 137.53 cells/mm compared to good baseline adherence, no opportunistic infection and undetectable viral load, respectively.

Conclusion: The immunological failure was relatively low. Maintaining adherence, early identification and treatment of opportunistic infections, and minimizing viral load to undetectable levels may further decrease immunological failure.

Citing Articles

Paradoxical and Unmasking HIV Immune Reconstitution Inflammation Syndrome in Antiretroviral-Naïve Pregnant Women: A Prospective Cohort Study.

Muthuka Jr J, Nyamai E, Oluoch K, Maibvise C, Nabaweesi R Cureus. 2024; 16(1):e52989.

PMID: 38406047 PMC: 10894621. DOI: 10.7759/cureus.52989.

Predictors associated with CD4 cell count changes over time among HIV-infected children on anti-retroviral therapy follow-up in Mekelle General Hospital, Northern Ethiopia, 2019: a retrospective longitudinal study.

Gebrerufael G BMC Pediatr. 2023; 23(1):628.

PMID: 38087261 PMC: 10714531. DOI: 10.1186/s12887-023-04401-7.

References

Bennett D, Myatt M, Bertagnolio S, Sutherland D, Gilks C . Recommendations for surveillance of transmitted HIV drug resistance in countries scaling up antiretroviral treatment. Antivir Ther. 2008; 13 Suppl 2:25-36. View

Kisakye P, Akena W, Kaye D . Pregnancy decisions among HIV-positive pregnant women in Mulago Hospital, Uganda. Cult Health Sex. 2010; 12(4):445-54. DOI: 10.1080/13691051003628922. View

Ford N, Meintjes G, Pozniak A, Bygrave H, Hill A, Peter T . The future role of CD4 cell count for monitoring antiretroviral therapy. Lancet Infect Dis. 2014; 15(2):241-7. DOI: 10.1016/S1473-3099(14)70896-5. View

Manaye G, Abateneh D, Kebede K, Belay A . Immunological Response During HAART and Determinants of Current CD4 T-Cell Count Among HIV/AIDS Patients Attending University of Gondar Referral Hospital, Northwest Ethiopia. HIV AIDS (Auckl). 2020; 12:295-306. PMC: 7411274. DOI: 10.2147/HIV.S255751. View

Dessie Z, Zewotir T, Mwambi H, North D . Modelling of viral load dynamics and CD4 cell count progression in an antiretroviral naive cohort: using a joint linear mixed and multistate Markov model. BMC Infect Dis. 2020; 20(1):246. PMC: 7098156. DOI: 10.1186/s12879-020-04972-1. View

Helleberg M, Kronborg G, Larsen C, Pedersen G, Pedersen C, Obel N . CD4 decline is associated with increased risk of cardiovascular disease, cancer, and death in virally suppressed patients with HIV. Clin Infect Dis. 2013; 57(2):314-21. DOI: 10.1093/cid/cit232. View

Waters L, Stebbing J, Jones R, Michailidis C, Sawleshwarkar S, Mandalia S . A comparison of the CD4 response to antiretroviral regimens in patients commencing therapy with low CD4 counts. J Antimicrob Chemother. 2004; 54(2):503-7. DOI: 10.1093/jac/dkh329. View

Weinberg J, Kovarik C . The WHO Clinical Staging System for HIV/AIDS. Virtual Mentor. 2012; 12(3):202-6. DOI: 10.1001/virtualmentor.2010.12.3.cprl1-1003. View

Williams P, Storm D, Montepiedra G, Nichols S, Kammerer B, Sirois P . Predictors of adherence to antiretroviral medications in children and adolescents with HIV infection. Pediatrics. 2006; 118(6):e1745-57. DOI: 10.1542/peds.2006-0493. View

10.

Bruneau L, Billaud E, Raffi F, Hanf M . Factors associated with the level of CD4 cell counts at HIV diagnosis in a French cohort: a quantile regression approach. Int J STD AIDS. 2016; 28(4):397-403. DOI: 10.1177/0956462416650980. View

11.

Gezie L . Predictors of CD4 count over time among HIV patients initiated ART in Felege Hiwot Referral Hospital, northwest Ethiopia: multilevel analysis. BMC Res Notes. 2016; 9:377. PMC: 4967525. DOI: 10.1186/s13104-016-2182-4. View

12.

Ojha C, Shakya G, Dumre S . Virological and Immunological Status of the People Living with HIV/AIDS Undergoing ART Treatment in Nepal. Biomed Res Int. 2016; 2016:6817325. PMC: 4980499. DOI: 10.1155/2016/6817325. View

13.

Charles M, Boyle B . Excess and access: the continuing controversy regarding HIV and health care in Africa. AIDS Read. 2002; 12(7):288-92. View

14.

Williams I, Churchill D, Anderson J, Boffito M, Bower M, Cairns G . British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012 (Updated November 2013. All changed text is cast in yellow highlight.). HIV Med. 2013; 15 Suppl 1:1-85. DOI: 10.1111/hiv.12119. View

15.

Lecher S, Williams J, Fonjungo P, Kim A, Ellenberger D, Zhang G . Progress with Scale-Up of HIV Viral Load Monitoring - Seven Sub-Saharan African Countries, January 2015-June 2016. MMWR Morb Mortal Wkly Rep. 2016; 65(47):1332-1335. DOI: 10.15585/mmwr.mm6547a2. View

16.

Roberts T, Cohn J, Bonner K, Hargreaves S . Scale-up of Routine Viral Load Testing in Resource-Poor Settings: Current and Future Implementation Challenges. Clin Infect Dis. 2016; 62(8):1043-8. PMC: 4803106. DOI: 10.1093/cid/ciw001. View

17.

Fokam J, Billong S, Jogue F, Ndiang S, Nga Motaze A, Paul K . Immuno-virological response and associated factors amongst HIV-1 vertically infected adolescents in Yaoundé-Cameroon. PLoS One. 2017; 12(11):e0187566. PMC: 5675438. DOI: 10.1371/journal.pone.0187566. View

18.

Molla A, Gelagay A, Mekonnen H, Teshome D . Adherence to antiretroviral therapy and associated factors among HIV positive adults attending care and treatment in University of Gondar Referral Hospital, Northwest Ethiopia. BMC Infect Dis. 2018; 18(1):266. PMC: 5992657. DOI: 10.1186/s12879-018-3176-8. View

19.

Ayele G, Tessema B, Amsalu A, Ferede G, Yismaw G . Prevalence and associated factors of treatment failure among HIV/AIDS patients on HAART attending University of Gondar Referral Hospital Northwest Ethiopia. BMC Immunol. 2018; 19(1):37. PMC: 6296084. DOI: 10.1186/s12865-018-0278-4. View

20.

Glass T, Motaboli L, Nsakala B, Lerotholi M, Vanobberghen F, Amstutz A . The viral load monitoring cascade in a resource-limited setting: A prospective multicentre cohort study after introduction of routine viral load monitoring in rural Lesotho. PLoS One. 2019; 14(8):e0220337. PMC: 6713472. DOI: 10.1371/journal.pone.0220337. View