Charles River Medical Group, Harare, Zimbabwe.
Unit of Internal Medicine, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe.
AIDS Res Hum Retroviruses. 2023 Jul;39(7):340-349. doi: 10.1089/AID.2022.0117. Epub 2023 Apr 26.
Presentation to care with advanced HIV disease (AHD) is a significant problem in sub-Saharan Africa. We evaluated factors associated with immune recovery among individuals presenting to care with AHD in Zimbabwe. We conducted a retrospective evaluation of outcomes among adult (>18 years old) individuals with AHD (CD4 count ≤200 cells/mm) receiving care at 18 outpatient primary care clinics in Harare, Zimbabwe. Baseline and 12-month CD4 count data were extracted from medical records. CD4 count recovery (defined as CD4 count >200 cells/mm) after 12 months on non-nucleotide reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) regimen was determined and factors associated with CD4 count recovery were established using logistic regression. All statistical analysis was performed on SPSS v23. A total of 1,338 participant records were included in the analysis. The median interquartile range (IQR) age was 37 (30-43) years and 52% were females. The baseline median (IQR) CD4 count was 50 (28-75) cells/mm and was significantly lower among patients with history of cryptococcal meningitis compared to those without [25 (10-52) vs. 52 (32-77), respectively; = .0009]. The median (IQR) CD4 count at 12 months after ART initiation increased from 50 (28-75) at baseline to 180 (92-290) cells/mm. Immune recovery with a CD4 count >200 cells/mm was observed in 181/417 (43%). Male gender and low baseline CD4 count were strong predictors of poor immunological recovery on ART. Immunological recovery following ART initiation was 43% among individuals with AHD. Male patients are most vulnerable to persistent immunological failure. Clinical Trial Registration number: NCT02434172.
在撒哈拉以南非洲，晚期艾滋病（AHD）患者就诊是一个重大问题。我们评估了津巴布韦的 AHD 患者就诊时与免疫恢复相关的因素。我们对津巴布韦哈拉雷的 18 个初级保健门诊的 AHD（CD4 计数≤200 个细胞/mm）成人（>18 岁）个体进行了回顾性结局评估。从病历中提取基线和 12 个月的 CD4 计数数据。确定在非核苷类逆转录酶抑制剂（NNRTI）为基础的抗逆转录病毒治疗（ART）方案治疗 12 个月后 CD4 计数恢复（定义为 CD4 计数>200 个细胞/mm），并使用逻辑回归确定与 CD4 计数恢复相关的因素。所有统计分析均在 SPSS v23 上进行。共纳入 1338 名参与者的记录进行分析。中位（IQR）年龄为 37（30-43）岁，52%为女性。基线时中位数（IQR）CD4 计数为 50（28-75）个细胞/mm，与无隐球菌性脑膜炎病史的患者相比显著降低[25（10-52）与 52（32-77）；=0.0009]。ART 开始后 12 个月的中位数（IQR）CD4 计数从基线时的 50（28-75）增加到 180（92-290）个细胞/mm。181/417（43%）例患者 CD4 计数>200 个细胞/mm 时出现免疫恢复。男性和低基线 CD4 计数是 ART 时免疫恢复不良的强烈预测因素。AHD 患者 ART 启动后免疫恢复率为 43%。男性患者最易发生持续免疫失败。临床试验注册号：NCT02434172。
