The effect of Aids defining conditions on immunological recovery among patients initiating antiretroviral therapy at JCRC, Kampala, Uganda

Abstract

BACKGROUND: During 2005, the world health organization (WHO) estimated that there were over 1.3 million people receiving antiretroviral therapy (ART). As the number of individuals able to access treatment is ever increasing, one of the programmatic challenges facing ART services in sub-Saharan Africa is that many HIV-infected patients only access health care once they have developed advanced symptomatic diseases resulting from AIDS Defining Conditions (ADCs). There are concerns that patients with ADCs may have limited potential to completely restore quantitative and functional immune status. OBJECTIVES: The objective of this study was to establish the effect of ADCs on immunological recovery among patients initiated on ART at joint clinical research centre, kampala. METHODS: A retrospective cohort of 427 HIV-1 ptients who were initiated on ART between January 2002 and December 2006 were studied. Data on ADCs was retrieved from JCRC database and backed up by chart reviews. We employed Kaplan-meier survival curves to estimate median time to immunological recovery and Mann-whitney’s test to compare the median change in CD4 count. Cox proportional hazard models and multiple regression methods were used at multivariate analysis. RESULTS: The median time to immunological recovery after ART initiation was longer in the ADC (9.3 months) compared to the non-ADC group (6.9 months) (log rank test, p=0.027). Factors that affected median time to immunological recovery after ART initiation were belonging to the non- ADC group (HR=1.31; 95%C1: 1.01-3.91, P=0.017), a low baseline CD4 count (HR= 0.98; C1:0.97-0.99, P=0.039) and adherence to ART of -> 95% (HR= 1.68; 95% C1:1.22-3.78, P=0.034). The ADC group had a lower median CD4 gain than that of the non-ADC group 12 months after ART initiation; 135 (IQR=156) vs. 170 cells/mm3 (IQR=134); (Mann-Whitney test, p=0.022) respectively. Factors that affected median gain in CD4 count after 12 months post ART initiation were presenting with no ADCs (B-coefficient=44.09; 95%c1:3.11-85.09, p=0.035), low baseline CD4 count (B-coefficient= -0.18; 95%C1: -0.29-0.08, P=0.001), High baseline viral load (B-coefficient= 5.86; 95%C1:0.14-11.59, P=0.045) and a high education level (B- coefficient= 37.51: 95% C1:12.53-62.49, P=0.003). CONCLUSIONS: Patients with ADCs take longer to regain their CD4 counts due to the defect in the immune system. This may prolong their risk of morbidity and mortality. After 12 months from ART initiation, the CD4 gain in ADC group was much lower than compared to that of non ADC group. A single CD4 count at 9 month may be useful in monitoring immunological recovery after ART initiation, if going on well.