Department of Statistics and Actuarial Science, Jomo Kenyatta University of Agriculture and Technology, P.O BOX 62000, 00200, Nairobi, Kenya.
CENSTAT, Universitiet Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.
BMC Infect Dis. 2022 Jan 4;22(1):29. doi: 10.1186/s12879-021-06977-w.
In resource-limited settings, changes in CD4 counts constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing. In this study, we quantified trends on CD4 counts in patients on highly active antiretroviral therapy (HAART) in a comprehensive health care clinic in Kenya between 2011 and 2017. We evaluated the rate of change in CD4 cell count in response to antiretroviral treatment. We further assessed factors that influenced time to treatment change focusing on baseline characteristics of the patients and different initial drug regimens used. This was a retrospective study involving 432 naïve HIV patients that had at least two CD4 count measurements for the period. The relationship between CD4 cell count and time was modeled using a semi parametric mixed effects model while the Cox proportional hazards model was used to assess factors associated with the first regimen change.
Majority of the patients were females and the average CD4 count at start of treatment was 362.1 [Formula: see text]. The CD4 count measurements increased nonlinearly over time and these trends were similar regardless of the treatment regimen administered to the patients. The change of logarithm CD4 cell count rises fast for in the first 450 days of antiretroviral initiation. The average time to first regimen change was 2142 days. Tenoforvir (TDF) based regimens had a lower drug substitution(aHR 0.2682, 95% CI:0.08263- 0.8706) compared to Zidovudine(AZT).
The backbone used was found to be associated with regimen changes among the patients with fewer switches being observed, with the use of TDF when compared to AZT. There was however no significant difference between TDF and AZT in terms of the rate of change in logarithm CD4 count over time.
在资源有限的环境下，CD4 计数的变化是患者监测和评估治疗反应的重要组成部分，因为这些患者无法进行常规病毒载量检测。在这项研究中，我们量化了肯尼亚一家综合保健诊所中接受高效抗逆转录病毒治疗（HAART）的患者在 2011 年至 2017 年期间 CD4 计数的趋势。我们评估了抗逆转录病毒治疗对 CD4 细胞计数变化的反应速度。我们进一步评估了影响治疗改变时间的因素，重点关注患者的基线特征和不同的初始药物方案。这是一项回顾性研究，涉及 432 名初次接受 HIV 治疗的患者，这些患者在该期间至少有两次 CD4 计数测量。使用半参数混合效应模型对 CD4 细胞计数与时间之间的关系进行建模，同时使用 Cox 比例风险模型评估与首次方案改变相关的因素。
大多数患者为女性，治疗开始时的平均 CD4 计数为 362.1[公式：见正文]。CD4 计数随着时间的推移呈非线性增加，这些趋势与给予患者的治疗方案无关。在抗逆转录病毒治疗开始后的 450 天内，对数 CD4 细胞计数的变化迅速增加。首次方案改变的平均时间为 2142 天。与齐多夫定（AZT）相比，替诺福韦（TDF）为基础的方案发生药物替代的可能性较低（aHR 0.2682，95%CI：0.08263-0.8706）。
研究发现，患者使用的骨干药物与方案改变有关，与 AZT 相比，使用 TDF 的方案改变较少。然而，在 CD4 计数对数随时间变化的速度方面，TDF 与 AZT 之间没有显著差异。
