Socio-demographic and treatment-related variables associated with CD4 cell counts in Kenyan HIV patients on second-line regimens
Abstract
Background: CD4 cell response in patients on second-line therapy has not been evaluated in Kenya. Patients failing second-line are changed to third-line, however, the drugs used for third-line are expensive and unavailable. Therefore, early identification of potential poor responders to treatment would lead to early intervention and thus improve therapy of patients on second-line.
Objectives: To identify socio-demographic and treatment related variables that affect CD4 response of HIV-positive patients on second-line regimens in Kenyatta National Hospital (KNH).
Methods: A historical cohort study carried out at KNH between January and April 2016 and entailed collection of patient data from the files. The main outcome variable was CD4 cell count. The predictor variables of interest were sex, age, education level, and ART regimens.
Results: All the study participants were on a lopinavir-based regimen. The study involved 84 study participants, 59.5% female study participants and 40.5% male. Male patients had significantly lower baseline CD4 cell counts and lower CD4 cell counts at ART (antiretroviral therapy) switch to second line compared to female patients. Efavirenz-based regimens were significantly associated with low CD4 cell count at ART switch to second-line.
Conclusion: Patients should be started on nevirapine-based regimens unless contraindicated.
Keywords: CD4 cell count, ART switch, second-line
References
Abrogoua DP, Brou JK, Boua ATK, Gilles A, Konan N, and Christian Z (2012). Assessment of the impact of adherence and other predictors during HAART on various CD4 cell responses in resource-limited settings. Patient Prefer Adherence. 6:227–237.
Alemu AW, and Miguel SS (2010). Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia. Glob. Health Action. 3:1–10.
Barry O, Powell J, Renner L, Bonney EY, Prin M, Ampofo W, Kusah J, Goka B, Sagoe KWC, Shabanova V and Paintsil E (2013). Effectiveness of first-line antiretroviral therapy and correlates of longitudinal changes in CD4 and viral load among HIV-infected children in Ghana. BMC Infect. Dis. 13:476
Coloccini RS , Dilernia D, Ghiglione Y, Turk G, Laufern N, Rubio A, SocíasME., Figueroa MI, Sued O, Cahn P, Salomón H, Mangano A and Pando MA (2014). Host Genetic Factors Associated with Symptomatic Primary HIV Infection and Disease Progression among Argentinean Seroconverters. PLoS One. 9:e113146.
Evans D, McNamara L, Maskew M, Selibas K, van Amsterdam D, Baines N, Webster T and Sanne I (2013). Impact of nutritional supplementation on immune response, body mass index and bioelectrical impedance in HIV-positive patients starting antiretroviral therapy. J. Nutr. 12:111.
Inzaule S, Otieno J, Kalyango J, Nafisa L, Kabugo C, Nalusiba J, Kwaro D, Zeh C and Karamagi C (2014). Incidence and Predictors of First Line Antiretroviral Regimen Modification in Western Kenya. PLoS One. 9:e93106
Iralu J, Duran B, Pearson CR, Jiang Y, Foley K, and Harrison M (2010). Risk Factors for HIV Disease Progression in a Rural Southwest American Indian Population. Public Health Reports, 125(Suppl 4):43–50.
Julg B, Poole D, Ghebremichael M, Castilla C, Altfeld M, Sunpath H, Murphy RA and Walker BD (2012). Factors predicting discordant virological and immunological responses to antiretroviral therapy in HIV-1 clade C infected zulu/xhosa in South Africa. PLoS One. 7:7–11.
Langford SE, Ananworanich J, and Cooper DA (2007). Predictors of disease progression in HIV infection: a review. AIDS Res. Ther. 4:11.
Montarroyos UR, Miranda-Filho DB, César CC, Souza WV, Lacerda HR, Albuquerque MDF, Aguiar MF and Ximenes RAD (2014). Factors related to changes in CD4+ T-cell counts over time in patients living with HIV/AIDS: A multilevel analysis. PLoS One. 9:e84276.
NASCOP (2011). Guidelines for antiretroviral therapy in adults. Ministry of Medical Services, Kenya.
NASCOP (2014a). Guidelines on use of Antiretroviral Drugs. Ministry of Health, Kenya.
NASCOP (2014b). Kenya HIV Estimates 2014.
Odafe S, Idoko O, Badru T, Aiyenigba B, Suzuki C, Khamofu H, Onyekwena O, Okechukwu E, Torpey K and Chabikuli ON (2012). Patients’ demographic and clinical characteristics and level of care associated with lost to follow-up and mortality in adult patients on first-line ART in Nigerian hospitals. J. Int. AIDS Soc. 15:1–9.
Parinitha SS, and Kulkarni MH (2012). Haematological changes in HIV infection with correlation to CD4 cell count. Australas. Med. J. 5:157–162.
Pinzone MR, Di Rosa M, Cacopardo B, and Nunnari G (2012). HIV RNA suppression and immune restoration: Can we do better? Clin. Dev. Immunol. Article ID 515962.
Teshome W and Assefa A (2014). Predictors of Immunological Failure of Antiretroviral Therapy among HIV Infected Patients in Ethiopia: A Matched Case-Control Study. PLoS One. 9: e115125.
UNAIDS (2013). Global Report.
Yirdaw KD and Hattingh S (2015). Prevalence and Predictors of Immunological Failure among HIV Patients on HAART in Southern Ethiopia. Plos One. 10:e0125826.
Zhu P, Zhu Q, Zhang Y, Ma X, Li Z, Li J , Chen J, Luo L, Ring HZ, Ring BZ and Su L (2013). ABCB1 Variation and Treatment Response in AIDS Patients: Initial Results of the Henan Cohort. PLoS One. 8: e55197.
Full Text: PDF
Refbacks
- There are currently no refbacks.