Manaye Gizachew Ayele, Abateneh Dejene Derseh, Kebede Kindie Mitiku, Belay Alemayehu Sayih
Mizan Tepi University, College of Health Sciences, Mizan Tefri, Ethiopia.
Kotebe Metropolitan University, Menelik II College of Medicine and Health Sciences, Addis Ababa, Ethiopia.
HIV AIDS (Auckl). 2020 Jul 31;12:295-306. doi: 10.2147/HIV.S255751. eCollection 2020.
After the initiation of highly active antiretroviral therapy (HAART), successful HAART is characterized by an increase in the CD4 count. Several factors affect the CD4 T-cell count. This study aimed to assess the immunological response during HAART and determinants of the current CD4 T-cell count among HIV/AIDS patients on HAART.
A hospital-based cross-sectional study was conducted from February 1 to April 1, 2017. A total of 423 HIV/AIDS patients on HAART were enrolled using simple random sampling. Descriptive statistics, and bivariate and multiple regression analyses were conducted. Variables with -value <0.2 in the bivariate analysis were entered in the multiple regression models. -Values <0.05 and 95% confidence intervals were used to identify determinants of the current CD4 T-cell count.
The mean CD4 T-cell count gradually increased until 8 years on HAART but declined thereafter. An increased current CD4 T-cell count was observed among patients with an initial regimen of pediatric d4T-3TC-NVP [=185.5, 95% CI (8.8, 362.2)] (=0.040), with increased baseline CD4 T-cell count [=0.468, 95% CI (0.342, 0.594)] (<0.0001), and with long duration on HAART [=18.0, 95% CI (9.9, 26.1)] (<0.0001), whereas a decreased level of current CD4 T-cell count was observed among males [=-72.7, 95% CI (-114.5, -30.9)]) (<0.0001) and those with poor baseline adherence [=-108.9, 95% CI (-210.9, -7.0)] (=0.036) and viral load >1000 copies [=-189.2, 95% CI (-243.5, -134.9)] (<0.0001).
The trend in immunological response was not increased linearly throughout the HAART duration. Sex, type of initial regimen, baseline adherence, baseline CD4 count, viral load, and duration on HAART were independent determinants of current CD4 count. These determinants could be addressed by regular monitoring of HIV patients on HAART, and special attention should be paid to male patients.
高效抗逆转录病毒治疗（HAART）开始后，成功的HAART表现为CD4细胞计数增加。多种因素会影响CD4 T细胞计数。本研究旨在评估HAART期间的免疫反应以及接受HAART的HIV/AIDS患者当前CD4 T细胞计数的决定因素。
于2017年2月1日至4月1日进行了一项基于医院的横断面研究。采用简单随机抽样方法，共纳入423例接受HAART的HIV/AIDS患者。进行了描述性统计、双变量和多变量回归分析。双变量分析中P值<0.2的变量被纳入多变量回归模型。P值<0.05和95%置信区间用于确定当前CD4 T细胞计数的决定因素。
HAART治疗8年之前，CD4 T细胞计数均值逐渐上升，但此后开始下降。初始治疗方案为儿科d4T-3TC-NVP的患者当前CD4 T细胞计数增加[β = 185.5，95% CI（8.8，362.2）]（P = 0.040），基线CD4 T细胞计数增加[β = 0.468，95% CI（0.342，0.594）]（P < 0.0001），且HAART治疗时间长[β = 18.0，95% CI（9.9，26.1）]（P < 0.0001）；而男性患者当前CD4 T细胞计数水平降低[β = -7,2.7，95% CI（-114.5，-30.9）]（P < 0.0001），基线依从性差的患者[β = -108.9，95% CI（-210.9，-7.0）]（P = 0.036）以及病毒载量>1000拷贝的患者[β = -189.2，95% CI（-243.5，-134.9）]（P < 0.0001）。
在整个HAART治疗期间，免疫反应趋势并非呈线性增加。性别、初始治疗方案类型、基线依从性、基线CD4计数、病毒载量以及HAART治疗时间是当前CD4计数的独立决定因素。对接受HAART的HIV患者进行定期监测可关注这些决定因素，且应特别关注男性患者。
