Immune reconstitution in human immunodeficiency virus-positive patients on highly active antiretroviral therapy at an urban public sector district hospital

Immune reconstitution is measured by circulating CD4 T cells that follows a biphasic pattern. Not everyone who is on highly active antiretroviral therapy (HAART) will attain immune reconstitution at the same rate, or to the same extent. This study aimed to describe the patterns of immune reconstitution in an urban public district hospital. A retrospective review of clinical files was performed on 354 patients who maintained virological suppression to <50 copies/ml over three years, following the initiation of HAART. Changes in CD4 T-cell count were described using descriptive statistics. Non-parametric analysis was conducted. Ninety-four per cent (n = 334) of patients had a baseline CD4 count <= 200 cells/ul, while only 0.3% (n = 1) had a baseline >350 cells/ul. The CD4 count increased from a median baseline of 92 cells/ul to 429 cells/ul over the three-year period. The CD4 count increased by 184 cells/ul, 72 cells/ul and 62 cells/ul in the first, second and third years, respectively. At the last determination, 37.3% (132) had a CD4 count >= 500 cells/ul and 6.8% (24) had a CD4 count <200 cells/ul. Females had a statistically significant (p-value <0.001) overall increase of 349 cells/ul, compared to the 273 cells/ul seen in males. Only 27.6% (53) of patients with a baseline CD4 cell count <100 cells/ul were able to attain levels >= 500 cells/ul. Despite the good response to HAART, patients with a baseline CD4 cell count <100 cells/ul were less likely to attain a normal CD4 count after three years of virological suppression on HAART than those with a higher baseline. (C) SAJID