Department of Statistics, College of Natural and Computational Science, Adigrat University, P.O. Box 50, Adigrat, Ethiopia.
BMC Pediatr. 2023 Dec 12;23(1):628. doi: 10.1186/s12887-023-04401-7.
AIDS continues to be a serious global public health issue. It targets CD4 cells and immunological cells, which are in charge of the body's resistance against pathogenic pathogens. In situations with limited resources, CD4 cell measurement is essential for assessing treatment responses and clinical judgments in HIV-infected children receiving Anti-Retroviral Therapy (ART). The volatility of CD4 cells during ART follow-up is still largely uncharacterized, and there are few new datasets on CD4 cell changes over time. Therefore, the purpose of this analysis was to identify the factors that were predictive of CD4 cell count changes over time in children who started ART at Mekelle General Hospital in northern Ethiopia.
A retrospective follow-up study was done. 437 patients in Mekelle general hospital, northern Ethiopia, from 2014-2016 were involved. All patients who have started anti-retrieval treatment (ART) and measured their CD4 cell count at least twice, including the baseline and those who initiated ART treatment, were included in the study population. An exploratory data analysis and linear mixed model analysis were used to explore the predictors of CD4 cell count change in patients and consider variability within and between patients.
This study found the correlation variation explained in cells accounted for between patients was 61.3%, and the remaining 38.7% variation existed within. This indicates that there is a substantial change in random slope and intercept between and within patients. WHO clinical stage IV (β = -1.30, 95% CI: -2.37, -0.23), co-infection HIV/TB (β = -1.78, 95% CI: -2.58, -0.98), children aged 2-5 (β = -0.43; 95% CI: -0.82, -0.04), and 6-14 years (β = -1.02; 95% CI: -1.47, -0.56), non-opportunistic infection (β = 1.33, 95% CI: 0.51, 2.14), and bedridden functional status (β = -1.74, 95% CI: -2.81, -0.68) were predictors of cell changes over time.
This study found that patients receiving ART experienced a significant change in CD4 cells over time. Because 61.3% of the variation in CD4 cells explained between patients and the remaining 38.7% within patients, such nested data structures are often strong correlation evidence. Co-infection of HIV/TB, functional status, age category of children, WHO clinical stage, and opportunistic infections are potential predictors of CD4 cells count change. Hence, special guidance and attention is also required, especially for those patients who have an opportunistic infections, higher WHO clinical stages, co-infections with HIV and TB, and bedridden functional status.
艾滋病仍然是一个严重的全球公共卫生问题。它针对的是 CD4 细胞和免疫细胞，这些细胞负责身体对病原体的抵抗力。在资源有限的情况下，CD4 细胞测量对于评估接受抗逆转录病毒治疗 (ART) 的 HIV 感染儿童的治疗反应和临床判断至关重要。在 ART 随访期间，CD4 细胞的波动性在很大程度上仍未得到充分描述，并且关于 CD4 细胞随时间变化的新数据集很少。因此，本分析的目的是确定在埃塞俄比亚北部 Mekelle 总医院开始接受 ART 的儿童中，哪些因素可以预测 CD4 细胞计数随时间的变化。
本研究采用回顾性随访研究。纳入了来自 2014 年至 2016 年埃塞俄比亚北部 Mekelle 总医院的 437 名患者。所有开始抗逆转录病毒治疗 (ART) 并至少两次测量 CD4 细胞计数的患者，包括基线和开始 ART 治疗的患者，都被纳入研究人群。采用探索性数据分析和线性混合模型分析来探讨患者 CD4 细胞计数变化的预测因素，并考虑患者内和患者间的变异性。
本研究发现，患者间解释的相关性变异占 61.3%，其余 38.7%的变异存在于患者内。这表明患者间和患者内的随机斜率和截距存在显著变化。世界卫生组织临床分期 IV 期 (β=-1.30,95%CI:-2.37,-0.23)、合并 HIV/TB 感染 (β=-1.78,95%CI:-2.58,-0.98)、年龄在 2-5 岁 (β=-0.43;95%CI:-0.82,-0.04)和 6-14 岁 (β=-1.02;95%CI:-1.47,-0.56)、非机会性感染 (β=1.33,95%CI:0.51,2.14)和卧床不起的功能状态 (β=-1.74,95%CI:-2.81,-0.68)是 CD4 细胞随时间变化的预测因素。
本研究发现，接受 ART 治疗的患者 CD4 细胞随时间发生显著变化。由于患者间 CD4 细胞变异的 61.3%和患者内剩余的 38.7%，这种嵌套数据结构通常是强相关性的证据。HIV/TB 合并感染、功能状态、儿童年龄类别、世界卫生组织临床分期和机会性感染是 CD4 细胞计数变化的潜在预测因素。因此，还需要特别的指导和关注，特别是对于那些有机会性感染、较高的世界卫生组织临床分期、HIV 和 TB 合并感染以及卧床不起的功能状态的患者。
