Trends of Immuno-virological Response Among HIV-Infected Patients Receiving Highly Active Anti-retroviral Therapy at Hawassa, Southern Ethiopia
Clinical Medicine Research
Volume 4, Issue 4, July 2015, Pages: 104-110
Received: Jun. 1, 2015;
Accepted: Jun. 11, 2015;
Published: Jun. 29, 2015
Views 4061 Downloads 119
Agete Tadewos Hirigo, Hawassa University, college of Medicine and Health Sciences, Department of Medical Laboratory Science, Hawassa, Southern Ethiopia
Demissie Assegu Fenta, Hawassa University, college of Medicine and Health Sciences, Department of Medical Laboratory Science, Hawassa, Southern Ethiopia
Tadewos Beyene Bala, Hawassa University, college of Medicine and Health Sciences, Referral Hospital, Hawassa, Southern Ethiopia
Selamawit Gutema Bule, Hawassa University, college of Medicine and Health Sciences, Referral Hospital, Hawassa, Southern Ethiopia
Meseret Regassa Gemechu, Hawassa University, college of Medicine and Health Sciences, Referral Hospital, Hawassa, Southern Ethiopia
Background: Immunological and virological response evaluation is one of a critical tool for assessing treatment outcome, regimen change and patient’s management. However, data concerning any change in immunological and virological response in HIV infected patients using anti-retroviral treatment (ART) is scarce in Ethiopia. Method: This retrospective cohort study was conducted from April 2010–September 2013 at ART clinic of Hawassa University referral hospital. A total of 86 HIV-infected patients receiving Tenofovir, Stavudine and Zidovudine based regimen with either of Efavirenz or Nevirapine during ART initiation. Lamivudine is common for all. Adequate immuno-virological response for most patients under treatment is defined as an increase in CD4 cells of 50–150/µl per year and viral load (VL) drops to undetectable level (<150 copies/ml) after ≥ 6 months of ART. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 20. Results: mean CD4+ cells count shows significant increment at 6, 12, 18 and 24 months after ART treatment among patients having VL <5 (log10) compared to those VL ≥5 (p=0.04; 0.002; < 0.0001; 0.001) respectively. Females have insignificantly better Mean CD4+ cells throughout 24 months. Also patients over 50 years of age do show an immune response after ART initiation. But, in relative to younger patients, their CD4 cells recovery is insignificantly sluggish. CD4+ cells and body weight of concordant positive responders show significant rising trend at 6, 12, 18, 24 months when compared to discordant responders + concordant non-responders, and p-value: (0.003 vs. 0.05; <0.0001 vs. 0.04; 0.001 vs.0.008; 0.001 vs.0.03) respectively. Moreover logistic regression models were applied and significant factors associated with discordant immuno-virological response were patient’s body weight (AOR=0.14; 95% CI: 0.03-0.7; p=0.02) and residence (AOR=20.3; 95% CI: 2.2-188; p=0.008). Conclusion: Immuno-virological response assessment is a critical tool for addressing treatment outcome, regimen change and patient’s management for those peoples living with HIV using ART. Therefore we recommend that treatment response decision should include both CD4+ cells count and viral load concurrently.
Agete Tadewos Hirigo,
Demissie Assegu Fenta,
Tadewos Beyene Bala,
Selamawit Gutema Bule,
Meseret Regassa Gemechu,
Trends of Immuno-virological Response Among HIV-Infected Patients Receiving Highly Active Anti-retroviral Therapy at Hawassa, Southern Ethiopia, Clinical Medicine Research.
Vol. 4, No. 4,
2015, pp. 104-110.
Palella FJ, Delaney KM, Moorman AC. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 1998; 338(13): 853–860.
WHO. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress report 2009.Availablefrom:URL:http://data.unaids.org/pub/Report/ 2009/20090930_tuapr_2009_en.pdf) accessed on 05 April 2015.
Moore DM, Hogg RS, Yip B, Wood E, Tyndall M, Braitstein P, Montaner JS. Discordant immunologic and virologic responses to highly active antiretroviral therapy are associated with increased mortality and poor adherence to therapy. J Acquir Immune Defic Syndr 2005; 40(3):288-293.
Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 2008; 48:293-9.
Teixeira PR, Vitoria MA, Barcarolo J. Antiretroviral treatment in resource-poor settings: the Brazilian experience. AIDS 2004; 18 (Suppl 3): S: 5-7.
Yamashita TE, Phair JP, Mun˜oz A, Margolick JB, Detels R, et al. Immunologic and virologic response to highly active antiretroviral therapy in the Multicenter AIDS Cohort Study. AIDS 2001; 15(6): 735–746.
Yeni P. Report of the expert group on the medical management of people infected with HIV: recommendations. 2008 report. Available from: http://www.sante.gouv.fr/rapport-du-groupe-d-experts-2008-surla- prise-en-charge-medicale-des-patients-infectees-par-le-vih-sousla-direction-du-pr-patrick-yeni.html. Accessed February 8, 2015.
Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. December 1, 2009. Available from:http://scap.org/documents/GuidlinesforAntiretrovialTher apy12-11-09.pdf. Accessed on Feb 10, 2015.
WHO: Antiretroviral Therapy for HIV infection in Adults and Adolescents: Recommendations for a public health approach 2006 revision. HIV/AIDS Programme: Strengthening health services to fight HIV/AIDS. Geneva: World Health Organization; 2006.
Benveniste O, Flahault A, Rollot F, Elbim C, Estaquier J, Pédron B, et al. Mechanisms involved in the low-level regeneration of CD4 cells in HIV 1 infected patients receiving highly active antiretroviral therapy who have prolonged undetecable plasma viral loads. J Infect Dis 2005; 191 (10):1670-1679.
Nicastri E, Chiesi A, Angeletti C, Sarmati L, Palmisano L, Geraci A, et al. Clinical outcome after 4 years follow-up of HIV-seropositive subjects with incomplete virologic or immunologic response to HAART. J Med Virol 2005; 76 (2):153-160.
Kranzer K, Houben RMG, Glynn JR, Bekker L-G, Wood R, Lawn SD. Yield of HIV-associated tuberculosis during intensified case finding in resource-limited settings: a systematic review and meta-analysis. Lancet Infect Dis 2010; 10:93–102.
Jevtovic D, Salemovic D, Ranin J, Pešic´I, Žerjav S, Djurkovic´-Djakovic O. The dissociation between virological and immunological responses with HAART. Biomedicine & Pharmacotherapy 2005; 59 (8): 446–451.
Taiwo BO, Li X, Palella F, Jacobson LP, Margolick JB, Detels R, et al. Higher Risk of AIDS or death in patients with lower CD4 Cell Counts after virally suppressive HAART. HIV Medicine 2009; 10 (10):657-660.
van Leth F, Phanuphak P, Stroes E, Gazzard B, Cahn P, Raffi F, et al. Nevirapine and efavirenz elicit different changes in lipid profiles in antiretroviral therapy-naïve patients infected with HIV-1. PLoS Med 2004; 1(1):e19.
Torres TS, Cardoso SW, de Souza VL, Marins LM, Oliveira MS, Veloso VG et al. Aging with HIV: An Overview of an Urban Cohort in Rio de Janeiro (Brazil) across Decades of Life. The Brazilian Journal of Infectious Diseases 2013; 17 (3): 324-331.
Greig J, Casas EC, O’Brien DP, Mills EJ, Ford N. Association between Older Age and Adverse Outcomes on Antiretroviral Therapy: A Cohort Analysis of Programme Data from Nine Countries. AIDS 2012; 26 (S-1): S31-S37.
Douek DC, McFarland RD, Keiser PH, Gage EA, Massey JM, Haynes BF, et al. Changes in thymic function with age and during the treatment of HIV infection. Nature 1998; 396 (6712): 690–695.
Florence E, Lundgren J, Dreezen C, Fisher M, Kirk O, Blaxhult A, et al. Factors associated with a reduced CD4 lymphocyte count response to HAART despite full viral suppression in the Euro-SIDA study. HIV Med 2003; 4(3):255-62.
Stuart J, Hamann D, Borleffs J, Roos M, Miedema F, Boucher F, et al. Reconstitution of naive T cells during antiretroviral treatment of HIV-infected adults is dependent on age. AIDS 2002; 16(17):2263-6.
Belay A, Alamrew Z, Berie Y, Tegegne B, Tiruneh G, Feleke A. Magnitude and correlates of tuberculosis among HIV patients at Felege Hiwot Referral Hospital, Bahir Dar city, northwest Ethiopia. Clinical medicine research 2013; 2(4): 77-83.
Misker D, Agidew E, Tilahun M, Mellie H. Time to increase WHO clinical stage of people living with HIV in public health facilities of Arba Minch town, south Ethiopia. Clinical medicine research 2014; 3(5): 119-124.
Moore AL, Kirk O, Johnson AM, Katlama C, Blaxhult A, Dietrich M, et al. Virologic, immunologic, and clinical response to highly active antiretroviral therapy: the gender issue revisited. J Acquir Immune Defic Syndr 2003; 32(4):452-61.
Nicastri E, Angeletti C, Palmisano L, Sarmati L, Chiesi A, Geraci A, et al. Gender differences in clinical progression of HIV-1-infected individuals during long-term highly active antiretroviral therapy. AIDS 2005; 19:577–583.
Collazos J, Asensi V, Carton JA. Sex differences in the clinical, immunological and virological parameters of HIV-infected patients treated with HAART. AIDS 2007; 21(7):835-843.
Zaragoza-Macias E, Cosco D, Nguyen ML, Del RC, Lennox J. Predictors of success with highly active antiretroviral therapy in an antiretroviral-naïve urban population. AIDS Res Hum Retroviruses 2010; 26 (2):133–138.
Barber TJ, Geretti AM, Anderson J, Schwenk A, Phillips AN, Bansi L, et al. Outcomes in the first year after initiation of first-line HAART among heterosexual men and women in the UK CHIC Study. Antivir Ther 2011; 16:805–814.
Maskew M, Brennan T, Westreich D, McNamara L, MacPhail P, Fox M. Gender Differences in Mortality and CD4 Count ResponseAmong Virally Suppressed HIV-Positive Patients. Journal of Women’s Health, 2013; 22(2):113-20.
Fardet L, Mary-Krause M, Heard I, Partisani M, Costagliola D. Influence of gender and HIV transmission group on initial highly active antiretroviral therapy prescription and treatment response. HIV Med 2006; 7(8):520-529.
Floridia M, Giuliano M, Palmisano L, Vella S. Gender differences in the treatment of HIV infection. Pharmacol Res 2008; 58(3-4):173-82.
Mocroft A, Philips AN, Gatell J, Ledergerber B, Fisher M. Normalisation of CD4 counts in patients with HIV-1 infection and maximum virological suppression who are taking combination antiretroviral therapy: an observational cohort study. Lancet 2007; 370(9585):407-13.
Patterson K, Napravnik S, Eron J, Keruly J, Moore R. Effects of age and sex on immunological and virological responses to initial highly active antiretroviral therapy. HIV Med 2007; 8(6):406-10.