Predictors of CD4+ Count Changes in HIV-Infected Patients Receiving Antiretroviral Therapy

Abstract

Abstract Introduction The CD4 + count is used to evaluate the clinical status of HIV-infected patients when deciding whether to initiate ART. To study the progression of HIV-infected patients on ART, CD4 + counts in each individual could be measured repeatedly to monitor the patient's AIDS progression and monitor treatment success. Therefore, this study aimed to identify predictors of CD4 + progression in HIV-positive patients receiving ART at the Debre Berhan Referral Hospital. Methods Retrospective data were collected from 322 HIV-infected patients who started ART in the hospital from September 2013 to February 2019. Exploratory analyses were applied to assess subject-specific and mean differences in terms of patients’ CD4 + progression. A linear mixed model was used as data analysis to account random effects. Results Of the 322 HIV-infected patients considered in the study, 225 (69.88%) were females. The baseline mean CD4 + counts was 335.7 and changed to 408.61 over 7 follow-up years. Moreover, predictors such as patients’ gender (male) (β =-0.7512, p-value = 0.019), age at initiation of ART (β = -0.02705, p-value = 0.047), bedridden functional status of the patients at initiation of ART (β = -0.03365, p-value = 0.021), TDF-3TC-NVP regimen class (β = -0.1474, p-value = 0.031), unmarried patients (β = 0.610, p-value = 0.011), patients’ WHO clinical stage-II (β = -0.402, p-value = 0.047), baseline CD4 count (β = 0.020, p-value = 0.0001) and follow-up time (β = 0.613, p-value = 0.0001) were positively as well as negatively associated and had significant impact on CD4 count progression. Conclusions Patients’ gender, age at initiation of ART, bedridden functional status at ART initiation, TDF-3TC-NVP treatment class, unmarried marital status, WHO clinical stage II, baseline CD4 count and follow-up time was found to be a significant predictor of the progression of a patient's CD4 count. Therefore, HIV-positive patients can be advised to start ART treatment as early as possible. Special guidance and attention is also required, especially in elderly patients, males with bedridden functional status, and late WHO clinical stage patients.