Department of Clinical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Medical Laboratory Science, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
PLoS One. 2022 Mar 24;17(3):e0265740. doi: 10.1371/journal.pone.0265740. eCollection 2022.
CD4+ cell count recovery after effective antiretroviral therapy (ART) is an important determinant of both AIDS and non-AIDS morbidity and mortality. Data on CD4+ cell count recovery after initiation of ART are still limited in Sub-Saharan Africa. The aim of this study was to assess CD4+ cell count recovery among HIV-infected adults initiating ART in an Ethiopian setting.
A retrospective cohort study of HIV-infected adults initiating ART between September 2008 and June 2019 was carried out. CD4+ cell count recovery was defined as an increase in CD4+ cell count of >100 cells/mm3 from baseline or achievement of a CD4+ cell count >500 cells/mm3 at 12 months after ART initiation. Factors associated with CD4+ cell count recovery were evaluated using logistic regression analysis.
Of the 566 patients included in this study, the median baseline CD4+ cell count was 264 cells/mm3 (IQR: 192-500). At 12 months after ART initiation, the median CD4+ cell count increased to 472 cells/mm3, and the proportion of patients with CD4+ cell count < 200 cells/mm3 declined from 28.3 to 15.0%. A total of 58.0% of patients had an increase in CD4+ cell count of >100 cells/mm3 from baseline and 48.6% achieved a CD4+ cell count >500 cells/mm3 at 12 months. Among patients with CD4+ cell counts < 200, 200-350 and >350 cells/mm3 at baseline, respectively, 30%, 43.9% and 61.7% achieved a CD4+ cell count >500 cells/mm3 at 12 months. In multivariable analysis, poor CD4+ cell count recovery (an increase of ≤100 cells/mm3 from baseline) was associated with older age, male sex, higher baseline CD4+ cell count and zidovudine-containing initial regimen. Factors associated with poor CD4+ cell count recovery to reach the level >500 cells/mm3 included older age, male sex and lower baseline CD4+ cell count.
CD4+ cell count failed to recover in a substantial proportion of adults initiating ART in this resource-limited setting. Older age, male sex and baseline CD4+ cell count are the dominant factors for poor CD4+ cell count recovery. Novel therapeutic approaches are needed focusing on high risk patients to maximize CD4+ cell count recovery and improve outcomes during therapy.
有效的抗逆转录病毒疗法（ART）后 CD4+ 细胞计数的恢复是艾滋病和非艾滋病发病率和死亡率的重要决定因素。在撒哈拉以南非洲，关于开始 ART 后 CD4+ 细胞计数恢复的数据仍然有限。本研究的目的是评估在埃塞俄比亚开展的 HIV 感染者开始 ART 后的 CD4+ 细胞计数恢复情况。
这是一项回顾性队列研究，纳入了 2008 年 9 月至 2019 年 6 月期间开始 ART 的 HIV 感染者。CD4+ 细胞计数恢复定义为基线时 CD4+ 细胞计数增加>100 个细胞/mm3，或在 ART 开始后 12 个月时 CD4+ 细胞计数达到>500 个细胞/mm3。使用逻辑回归分析评估与 CD4+ 细胞计数恢复相关的因素。
本研究共纳入了 566 例患者，基线时 CD4+ 细胞计数中位数为 264 个细胞/mm3（IQR：192-500）。在 ART 开始后 12 个月时，CD4+ 细胞计数中位数增加到 472 个细胞/mm3，CD4+ 细胞计数<200 个细胞/mm3的患者比例从 28.3%下降到 15.0%。共有 58.0%的患者基线时 CD4+ 细胞计数增加>100 个细胞/mm3，48.6%的患者在 12 个月时 CD4+ 细胞计数>500 个细胞/mm3。在基线 CD4+ 细胞计数<200、200-350 和>350 个细胞/mm3的患者中，分别有 30%、43.9%和 61.7%在 12 个月时 CD4+ 细胞计数>500 个细胞/mm3。多变量分析显示，较差的 CD4+ 细胞计数恢复（与基线相比增加≤100 个细胞/mm3）与年龄较大、男性、较高的基线 CD4+ 细胞计数和含齐多夫定的初始方案相关。与未能达到 CD4+ 细胞计数>500 个细胞/mm3的水平相关的因素包括年龄较大、男性和较低的基线 CD4+ 细胞计数。
在资源有限的环境中，相当一部分开始 ART 的成年人的 CD4+ 细胞计数未能恢复。年龄较大、男性和基线 CD4+ 细胞计数是 CD4+ 细胞计数恢复不良的主要因素。需要新的治疗方法，重点关注高危患者，以最大限度地提高 CD4+ 细胞计数恢复，并改善治疗期间的结果。
