Nanzigu Sarah, Kiguba Ronald, Kabanda Joseph, Mukonzo Jackson K, Waako Paul, Kityo Cissy, Makumbi Fred
Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda ; Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.
Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.
HIV AIDS (Auckl). 2013 Dec 6;5:309-19. doi: 10.2147/HIV.S50614. eCollection 2013.
CD4 T lymphocytes remain the surrogate measure for monitoring HIV progress in resource-limited settings. The absolute CD4 cell counts form the basis for antiretroviral therapy (ART) initiation and monitoring among HIV-infected adults. However, the rate of CD4 cell change differs among patients, and the factors responsible are inadequately documented.
This study investigated the relationship between HIV severity and ART outcomes among ART-naïve Ugandans, with the primary outcome of complete immunological recovery among patients of different baseline CD4 counts.
Patients' records at two HIV/ART sites - the Joint Clinic Research Centre (JCRC) in the Kampala region and Mbarara Hospital in Western Uganda - were reviewed. Records of 426 patients - 68.3% female and 63.2% from JCRC - who initiated ART between 2002 and 2007 were included. HIV severity was based on baseline CD4 cell counts, with low counts considered as severe immunosuppression, while attaining 418 CD4 cells/μL signified complete immunological recovery. Incidence rates of complete immunological recovery were calculated for, and compared between baseline CD4 cell categories: <50 with ≥50, <100 with ≥100, <200 with ≥200, and ≥200 with ≥250 cells/μL.
The incidence of complete immunological recovery was 158 during 791.9 person-years of observation, and patients with baseline CD4 ≥ 200 cells/μL reached the end point of immunological recovery 1.89 times faster than the patients with baseline CD4 < 200 cells/μL. CD4 cell change also differed by time, sex, and site, with a faster increase observed during the first year of treatment. CD4 cell increase was faster among females, and among patients from Mbarara.
Initiating ART at an advanced HIV stage was the main reason for poor immunological recovery among Ugandans. Earlier ART initiation might lead to better immunological responses.
在资源有限的环境中，CD4 T淋巴细胞仍然是监测HIV进展的替代指标。绝对CD4细胞计数是HIV感染成年人开始抗逆转录病毒治疗（ART）和监测的基础。然而，患者之间CD4细胞变化的速率不同，且相关影响因素的记录并不充分。
本研究调查了未接受过ART的乌干达人中HIV严重程度与ART治疗结果之间的关系，主要结局是不同基线CD4计数患者的完全免疫恢复。
回顾了两个HIV/ART治疗点（坎帕拉地区的联合临床研究中心（JCRC）和乌干达西部的姆巴拉拉医院）患者的记录。纳入了2002年至2007年间开始接受ART治疗的426例患者的记录，其中女性占68.3%，来自JCRC的患者占63.2%。HIV严重程度基于基线CD4细胞计数，低计数被视为严重免疫抑制，而达到418个CD4细胞/μL表示完全免疫恢复。计算并比较了基线CD4细胞类别（<50与≥50、<100与≥100、<200与≥200以及≥200与≥250细胞/μL）的完全免疫恢复发生率。
在791.9人年的观察期内，完全免疫恢复的发生率为158例，基线CD4≥200细胞/μL的患者达到免疫恢复终点的速度比基线CD4<200细胞/μL的患者快1.89倍。CD4细胞变化也因时间、性别和治疗点而异，在治疗的第一年观察到更快的增加。女性以及来自姆巴拉拉的患者中CD4细胞增加更快。
在HIV晚期开始ART治疗是乌干达人免疫恢复不佳的主要原因。更早开始ART治疗可能会带来更好的免疫反应。
