Factors associated with CD4+ cell count recovery among males and females with advanced HIV disease

被引:1
作者
Kouamou, Vinie [1 ,2 ,3 ]
Gundidza, Patricia [1 ]
Ndhlovu, Chiratidzo Ellen [1 ,2 ]
Makadzange, Azure Tariro [1 ]
机构
[1] Univ Zimbabwe, Charles River Med Grp, Harare, Zimbabwe
[2] Univ Zimbabwe, Dept Primary Hlth Care Sci, Unit Internal Med, Harare, Zimbabwe
[3] 52 Alpes Rd,Vainona, Harare, Zimbabwe
关键词
advanced HIV disease; HIV/AIDS; immune recovery; males; sub-Saharan Africa; RECONSTITUTION INFLAMMATORY SYNDROME; ANTIRETROVIRAL THERAPY INITIATION; REFERENCE RANGES; ADULTS; DOLUTEGRAVIR; TUBERCULOSIS; WOMEN; MEN; AGE;
D O I
10.1097/QAD.0000000000003695
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: HIV/AIDS mortality remains significantly high in sub-Saharan Africa, mostly driven by opportunistic infections and advanced HIV disease (AHD). This study aimed to assess CD4(+) cell count recovery following ART initiation and factors associated with immune reconstitution. Methods: We conducted a prospective cohort study between 2015 and 2016. HIV infected adults (>18 years) with AHD (CD4(+) cell count <100 cells/mu l) receiving care at 20 outpatient HIV treatment facilities in Harare, Zimbabwe were enrolled. CD4(+) cell count recovery (CD4(+) cell count >200 cells/mu l) was assessed following 12-month ART initiation and factors associated with immune reconstitution were investigated using logistic regression analysis. All statistical analyses were performed on Statistical Package for the Social Sciences (SPSS) version 23. Results: 1320 participants were enrolled and 56.4% were males. The median (inter quartile range, IQR) age was 37 (32-43) years. Tuberculosis was seen in 16.0%. Of the 739 participants that had CD4(+) cell count at 12 months, CD4(+) cell count recovery above 200 cells/mu l was observed in 163 (22.1%) participants. Median (IQR) CD4(+) cell count at 12-months increased to 127 (75-190) cells/mu l from 31 (14-55) at baseline. Factors associated with CD4(+) cell count recovery were younger age at baseline [odds ratio (OR)(>= 40/<40) = 0.58, 95% confidence interval (CI): 0.40-0.85, P = 0.005), sex (ORfemale/male = 2.07, 95% CI: 1.44-2.99, P < 0.0001) and baseline CD4(+) cell count (OR >= 50/<50 = 1.60, 95% CI: 1.10-2.33, P = 0.013). Conclusion: A significant proportion (77.9%) of patients seeking care with AHD in a resource limited setting failed to recover a CD4(+) cell count >200 cells/mu l. Male sex, older age and low CD4(+) cell count at ART initiation were factors associated with poor immune reconstitution. Better differentiated care deliveries targeting this vulnerable population are critical for improving clinical outcomes and quality of life of the patients. Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved.
引用
收藏
页码:2311 / 2318
页数:8
相关论文
共 46 条
[41]  
UNAIDS, 2022, epidemiological estimates
[42]   Long-Term Safety and Efficacy of Dolutegravir in Treatment-Experienced Adolescents With Human Immunodeficiency Virus Infection: Results of the IMPAACT P1093 Study [J].
Viani, Rolando M. ;
Ruel, Theodore ;
Alvero, Carmelita ;
Fenton, Terry ;
Acosta, Edward P. ;
Hazra, Rohan ;
Townley, Ellen ;
Palumbo, Paul ;
Buchanan, Ann M. ;
Vavro, Cindy ;
Singh, Rajendra ;
Graham, Bobbie ;
Anthony, Patricia ;
George, Kathleen ;
Wiznia, Andrew .
JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY, 2020, 9 (02) :159-165
[43]   Influence of age on CD4 cell recovery in human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy: Evidence from the EuroSIDA study [J].
Viard, JP ;
Mocroft, A ;
Chiesi, A ;
Kirk, O ;
Roge, B ;
Panos, G ;
Vetter, N ;
Bruun, JN ;
Johnson, M ;
Lundgren, JD .
JOURNAL OF INFECTIOUS DISEASES, 2001, 183 (08) :1290-1294
[44]  
WHO, 2022, GUID DIAGN PREV MAN
[45]  
World Health Organization, 2019, WHO Library Cataloguing in Publication Data
[46]   A retrospective clinical study of dolutegravir- versus efavirenz-based regimen in treatment-naive patients with advanced HIV infection in Nanjing, China [J].
Zhong, Mingli ;
Li, Mengqing ;
Qi, Mingxue ;
Su, Yifan ;
Yu, Nawei ;
Lv, Ru ;
Ye, Zi ;
Zhang, Xiang ;
Xu, Xinglian ;
Cheng, Cong ;
Chen, Chen ;
Wei, Hongxia .
FRONTIERS IN IMMUNOLOGY, 2023, 13