scholarly journals Modelling trends of CD4 counts for patients on antiretroviral therapy (ART): a comprehensive health care clinic in Nairobi, Kenya

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Caroline W. Mugo ◽  
Ziv Shkedy ◽  
Samuel Mwalili ◽  
Tadesse Awoke ◽  
Roel Braekers ◽  
...  
Keyword(s):  
Cell Count ◽  
Rate Of Change ◽  
Cd4 Count ◽  
Comprehensive Health Care ◽  
Care Clinic ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Regimen Change ◽  
Comprehensive Health ◽  
Cd4 Cell

Abstract Background In resource-limited settings, changes in CD4 counts constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing. In this study, we quantified trends on CD4 counts in patients on highly active antiretroviral therapy (HAART) in a comprehensive health care clinic in Kenya between 2011 and 2017. We evaluated the rate of change in CD4 cell count in response to antiretroviral treatment. We further assessed factors that influenced time to treatment change focusing on baseline characteristics of the patients and different initial drug regimens used. This was a retrospective study involving 432 naïve HIV patients that had at least two CD4 count measurements for the period. The relationship between CD4 cell count and time was modeled using a semi parametric mixed effects model while the Cox proportional hazards model was used to assess factors associated with the first regimen change. Results Majority of the patients were females and the average CD4 count at start of treatment was 362.1 $$cell/mm^3$$ c e l l / m m 3 . The CD4 count measurements increased nonlinearly over time and these trends were similar regardless of the treatment regimen administered to the patients. The change of logarithm CD4 cell count rises fast for in the first 450 days of antiretroviral initiation. The average time to first regimen change was 2142 days. Tenoforvir (TDF) based regimens had a lower drug substitution(aHR 0.2682, 95% CI:0.08263- 0.8706) compared to Zidovudine(AZT). Conclusion The backbone used was found to be associated with regimen changes among the patients with fewer switches being observed, with the use of TDF when compared to AZT. There was however no significant difference between TDF and AZT in terms of the rate of change in logarithm CD4 count over time.

scholarly journals Modelling Trends of Cd4 Counts for Patients on Antiretroviral Therapy (Art) : After a Change in Who Guidelines in Kenya

2021 ◽  
Author(s):  
Caroline W Mugo ◽  
Ziv Shkedy ◽  
Samuel Mwalili ◽  
Roel Braekers ◽  
Dolphine Wandede ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Cd4 Count ◽  
Care Clinic ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Significant Difference ◽  
Drug Regimens ◽  
Cd4 Cell ◽  
Over Time

Abstract Background In resource-limited settings, changes in CD4 counts constitute an important component in patient monitoring and evaluation of treatment response as these patients do not have access to routine viral load testing. In this study, we quantified trends on CD4 counts in patients on highly active antiretroviral therapy (HAART) in a comprehensive health care clinic in Kenya between 2011 and 2017.We evaluated the rate of change in CD4 cell count in response to antiretroviral treatment. We further assessed factors that influenced time to treatment change focusing on baseline characteristics of the patients and different initial drug regimens used. The study involved 529 naïve HIV patients that had at least two CD4 count measurements for the period. The relationship between CD4 cell count and time was modeled using a semi parametric mixed effects model while the Cox proportional hazards model was used to assess factors associated with the first regimen change. Results The results demonstrated that CD4 counts increased over time and these trends were similar regardless of the treatment regimen used. Males were less likely to have drug regimens switch (adjusted hazard ratio (aHR) 0.5101, 95% CI: 0.1906 -1.3647) compared to females.Tenoforvir (TDF) based regimens had a lower drug substitution (aHR 0.2796, 95% CI: 0.0961-0.8629) compared to Zinovudine (AZT). Conclusion The backbone used was found to be associated with regimen changes among the patients with fewer switches being observed, with the use of TDF when compared to AZT. There was however no significant difference between TDF and AZT in terms of the change in CD4 count over time.

scholarly journals Frequency of Cytomegalovirus Viral Load in Iranian Human Immunodeficiency Virus-1-Infected Patients with CD4+ Counts <100 Cells/mm3

Intervirology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Mohammad Reza Jabbari ◽  
Hoorieh Soleimanjahi ◽  
Somayeh Shatizadeh Malekshahi ◽  
Mohammad Gholami ◽  
Leila Sadeghi ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Cell Count ◽  
Previous History ◽  
Cd4 Count ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Cd4 Cell ◽  
Hiv 1

<b><i>Objectives:</i></b> The aim of present work was to assess cytomegalovirus (CMV) viremia in Iranian human immunodeficiency virus (HIV)-1-infected patients with a CD4+ count &#x3c;100 cells/mm<sup>3</sup> and to explore whether CMV DNA loads correlate with CD4+ cell counts or associated retinitis. <b><i>Methods:</i></b> This study was conducted at the AIDS research center in Iran on HIV-1-infected patients with CD4+ count &#x3c;100 cells/mm<sup>3</sup>, antiretroviral therapy-naive, aged ≥18 years with no previous history of CMV end-organ disease (CMV-EOD). <b><i>Results:</i></b> Thirty-nine of 82 patients (47.56%) had detectable CMV viral load ranging from 66 to 485,500 IU/mL. CMV viral load in patients with retinitis ranges from 352 to 2,720 IU/mL, and it was undetectable in 2 patients. No significant associations between CMV viremia and CD4+ cell count was found (<i>p</i> value = 0.31), whereas significant association of CMV viremia in HIV-infected patients with retinitis was found (<i>p</i> &#x3c; 0.02). <b><i>Conclusions:</i></b> We estimated the frequency of CMV viral load infection in Iranian HIV-1-infected patients with a CD4+ cell count &#x3c;100 mm<sup>3</sup>/mL in the largest national referral center for HIV-1 infection in Iran. Further research is required on the relevance of CMV viral load in diagnostic and prognostic value of CMV-EOD.

scholarly journals Assessment of Markers of Depression and CD4 Cell Count among Adult HIV-Positive Patients on Anti-Retroviral at a Nigerian University Teaching Hospital

2020 ◽  
Vol 8 (4) ◽  
pp. 283-290
Author(s):  
A. Amoko ◽  
P.O. Ajiboye ◽  
F.A. Olagunju ◽  
R.O. Shittu
Keyword(s):  
Family Medicine ◽  
Cell Count ◽  
Teaching Hospital ◽  
Cd4 Count ◽  
Hiv Positive ◽  
P Value ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Prevalence Of Depression ◽  
Cd4 Cell

Objective: Depression is a common mental health problem among people living with HIV/AIDS (PLWHA); because low count of lymphocytes with  cluster of differentiation 4 (CD4 cell count) is associated with severe symptoms of HIV infection, there are thoughts that low CD4 cells count can provoke depressive illness. This study was conducted to determine the relationship between CD4 count and depression among adult HIV positivepatients attending Family Medicine clinics at University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.Method: A hospital based descriptive cross-sectional study was done over a period of 6 months among 350 systematically randomly selected adult HIV-positive patients. PHQ-9 was used to obtain information on depression and the CD4 count was determined using a flow-cytometric method. Data were obtained and analyzed using SPSS-17. Chi-square was used to determine degree of association between the depression and the level of CD4 count. P-value of < 0.05 was considered statistically significant.Results: The prevalence of depression among the respondents was 33.4%. The prevalence of depression was highest among respondents with low CD4 count (≤349cells/ul), 37.0%, and least among those with high CD4 count (≥500cells/ul), 28.3%. This relationship was however not statistically significant.Conclusion: The overall prevalence of depression was high among the respondents (33.4%) suggesting the need for routine depression screening among HIV positive patients. There was no statistically significant association between presence of depression and level of CD4 count (p-value=0.302). Keywords: Depression, CD4count, PLWHA, Family Medicine, UITH.

scholarly journals The correlation of tuberculosis smear results and immuno-suppression with CD4+ counts as a surrogate marker among HIV infected patients.

2021 ◽  
Author(s):  
Kingsley Kamvuma ◽  
Yusuf ademola ◽  
Warren Chanda ◽  
Christopher Newton Phiri ◽  
Sam Bezza Phiri ◽  
...  
Keyword(s):  
Cell Count ◽  
Surrogate Marker ◽  
Hiv Positive ◽  
Sputum Smear ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Study Participants ◽  
Cd4 Cell

Abstract Background: Human immunodeficiency virus (HIV) and M.tuberculosis are two intracellular pathogens that interact at the cellular, clinical and population levels. Since the recognition of AIDS in 1981, the number of reported cases of TB in the has increased substantially, especially in regions with high incidence of AIDS. The main aim of this study was to establish weather there is a relationship between sputum smear positives and low CD4 cell counts among HIV infected patients.Materials and methods: This was a retrospective study involving 473 participants. The patients recruited in this study were those who tested HIV positive and smear positive for TB. Their HIV status was determined by performing an HIV blood test, if they were HIV positive their CD4 cell count were then made.Results: This study examined the relation between smear positivity and low CD4 (below 200cells/µl) together with CD8 and CD3 markers as a measure of immune function among patients infected with HIV. The study participants’ constituted males 67% and females 33%. The overall mean age was 33.2 (SD 6.9) with the youngest and oldest participants being 18 and 60 respectively. It was found that smear positive results negatively (r=-0.13; p=0.021) correlated with CD4+ below 200 cells/µl. No correlation was observed between smear positives and CD8+ or CD3+ since the calculated correlation coefficient was not significant 0.007 (p=0.9) and 0.03 (p=0.6) respectively. There are more 3+ smear results below 200 cells/µl than the others while above 200 cells/µl 1+ was the most commonly reported smear result. The scanty smear positives were the least commonly reported result in the low and high CD4 counts. Conclusion: The smear positive result negatively correlated with a low CD4+ (r=-0.13; p=0.021) but no correlation with low CD+8 and CD+3 results was observed. The long held theory that low bacillary counts in patients with low CD4+ counts needs to be revisited. The reduction of CD4+ cell count parallels' that of the total lymphocyte count and is more marked in patients with high bacillary counts. Further, studies are required to confirm these findings

CUTANEOUS MANIFESTATIONS OF HIV IN PEOPLE LIVING WITH HIV/AIDS AT TERTIARY CENTRE

2021 ◽  
pp. 70-72
Author(s):  
Anubhav Agrawal ◽  
Simmi Dube ◽  
Aditya Tejwani
Keyword(s):  
Cell Count ◽  
Tertiary Care ◽  
Skin Lesions ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Cutaneous Manifestations ◽  
Cd4 Cell Count ◽  
Cd4 Cell

BACKGROUND-The study was conducted to describe systematic clinical manifestations among HIV in PLHA at tertiary care centre. METHODOLOGY- This study was designed as cross sectional study at Department of Medicine, tertiary care centre. A total of 100 HIV infected patients were included detailed enquiry about presence of skin lesions along with CD4 cell count was obtained and entered in pretested questionnaire RESULTS-The mean age of patients with HIV was 43.9±10.2 years and Slight female preponderance was observed with male: 3 female ratio of 0.89:1. Mean CD4 count was 243.2±103.2 cells/mm . Majority of patients had CD4 count in the range of less than 3 200 cells/mm (64%) Staphylococcal skin infections were the most common skin lesions observed in 34% patients. All the patients with cutaneous manifestations presented in present study had low CD4 cell count. However, no statistically signicant association between CD4 count and cutaneous manifestations could be documented (p>0.05). CONCLUSION-Cutaneous manifestations are more prevalent in patients with lower CD4 counts and can also be observed with normal CD4 count levels amongst patients with HIV. Occurrence of cutaneous manifestations was higher in patients with lower CD4 count but the observed difference was not statistically signicant.

scholarly journals IS IT SAFE AND COST SAVING TO DEFER THE CD4+ CELL COUNT MONITORING IN STABLE PATIENTS ON ART WITH MORE THAN 350 OR 500 CELLS/µL?

2019 ◽  
Vol 11 (1) ◽  
pp. e2019063
Author(s):  
Benedetto Maurizio Celesia ◽  
Andrea Marino ◽  
Rosa Fontana del Vecchio ◽  
Roberto Bruno ◽  
Filippo Palermo ◽  
...  
Keyword(s):  
Cell Count ◽  
Mean Value ◽  
Cd4 Count ◽  
Cd4 Cells ◽  
Cd4 Cell Count ◽  
The Third ◽  
Cd4 Lymphocyte ◽  
Mean Cost ◽  
Cd4 Cell

Background CD4 lymphocyte cell count represents the main immunological marker used to monitor HIV infection. However, frequent monitoring may be unnecessary, could cause anxiety to the patient as well as burdening healthcare with extra expenses.   Objectives and methods To analyse the probability of maintaining a safe number of CD4 in HIV-positive subjects under treatment with ≥350 cells/µl at baseline during a three-year follow up. We conducted a retrospective study performing three analyses with Kaplan-Meyer method considering: 1) all patients independently from their viral load (VL); 2) patients with 500 > CD4 ≥ 350 cells/µl versus (vs) CD4 ≥ 500 cells/µl at baseline; 3) patients with VL < 20 copies/ml vs VL > 20 copies/ml.   Results 253 subjects were enrolled. The median CD4 count was 623 (489-805) cells/µl. Subjects maintaining ≥ 350 cells/µl in the first, second and third year were respectively 238 (94.1%), 229 (90.5%) and 226 (89.3%), independently from VL. Within subjects with ≥ 350 CD4/µl vs ≥ 500 CD4/µl at baseline, those who maintained ≥ 350 cells/µl until the third year were respectively 241 (95.3%) and 158 (98.1%). The probability of maintaining these values in the third year was 89.3% for those who had CD4 ≥ 350/µl at baseline and 98.1% for those who had CD4 ≥ 500/µl. This probability was around 90% vs 99% for subjects with HIV-RNA above or below 20 copies/ml. Secondly, we tried to estimate the costs of CD4 determinations in a three-year period (from April 1, 2013 to March 31, 2016). We analysed respectively 343 subjects in the first period, 364 in the second and 383 in the third, with a median value of 500 CD4/µl during the research time taken into account. We found a mean value of about two determinations patient/year (2.41 in 2013/2014; 2.32 in 2014/2015; 2.18 in 2015/2016), with a significant decrease between the first and the last period (p<0.001). The mean cost patient/year was €101.51 in the first year, €97.61 in the second, €92.00 in the third (p<0,001). Assuming to extend these procedures to all our patients with stable CD4 cells/µl and monitoring CD4 cell count once in a year, it could be possible to obtain an overall saving of €19,152/year.   Conclusions A very high percentage of subjects maintained a high and safe number of CD4 cells (>350 cells/µl) during a three-year follow up. It could be possible to save up to 66% of the costs by reducing the number of CD4 count determinations in a year, to have other favourable consequences as well, releasing new resources for patient’s management.

scholarly journals A clinico epidemiological study of pediatric dermatoses of HIV infected children in a tertiary care hospital of North Bengal

2021 ◽  
Vol 8 (11) ◽  
pp. 1837
Author(s):  
Mrinmoy Bairagi ◽  
Tanushree Mandal ◽  
Balai Chandra Karmakar
Keyword(s):  
Hiv Infection ◽  
Cell Count ◽  
Epidemiological Study ◽  
Skin Lesions ◽  
Pediatric Hiv ◽  
Hiv Positive ◽  
Care Hospital ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Cd4 Cell

Background: Pediatric Human immunodeficiency virus (HIV) infection and its dermatological manifestation has emerged a serious burden globally including India. Dermatological manifestations are unique in pediatric HIV infection and related to CD4 cell count and its percentage. The study was carried out to assess the cutaneous manifestation of HIV positive pediatric patients and its correlation with CD4 cell count in eastern part of India below 12 years of age.Methods: This analytic epidemiological study with prospective observational design was carried among 30 HIV positive children below 12 years of age in our institution over a period of one year.Results: Total 30 HIV infected children were studied among male 23 (76.67%)) and female 7 (23.33%). Age ranged from birth to 12 years with mean was 6.39±2.48 years. The skin lesions are highest in 3-6 yrs age group 12 (40%) and 33.33% of them had CD4 counts between 500-750 while 3.33% had CD4 counts above 1500. 27 patients (90%) were received ART and 3 (10%) patients were without ART. Nine distinct patterns of lesions: abscess (3), furuncles (1), maculopapular rash (2), papular (7), pruritic (10), plaque (3), soreness of tongue (2), pustules (1) and red scaly (1) were detected. 46.67% pain (14), 40.0% itching (12) and 13.33% burning sensation (4) were the main symptoms and 20.0% face (6), 16.7% oral cavity (5), 20.0% hands (6), 10.0% abdomen (3) and 33.3% legs (10) were principal site of involvement. 13 different skin lesions: fungal infection (3), furuncles (1), urticaria (4), scabies (5), prurigo (5), measles (1), molluscum contagiosum (1), abscess (3), venous leg (1), pyoderma (1), atopic dermatitis (1), chicken pox (2) and glossitis (2) were diagnosed.Conclusions: Various dermatological manifestations are common with pediatric HIV infection and sometime are the first clinical presentation that is well correlated with CD4 cell count and its percentage.  

scholarly journals Achieving Universal Access for Human Immunodeficiency Virus and Tuberculosis: Potential Prevention Impact of an Integrated Multi-Disease Prevention Campaign in Kenya

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Reuben Granich ◽  
Nicolas Muraguri ◽  
Alexandre Doyen ◽  
Navneet Garg ◽  
Brian G. Williams
Keyword(s):  
Disease Prevention ◽  
Cell Count ◽  
Universal Access ◽  
Hiv Infections ◽  
Nyanza Province ◽  
Cd4 Cell Count ◽  
Cd4 Counts ◽  
Cell Counts ◽  
Prevention Campaign ◽  
Cd4 Cell

In 2009, Government of Kenya with key stakeholders implemented an integrated multi-disease prevention campaign for water-borne diseases, malaria and HIV in Kisii District, Nyanza Province. The three day campaign, targeting 5000 people, included testing and counseling (HTC), condoms, long-lasting insecticide-treated bednets, and water filters. People with HIV were offered on-site CD4 cell counts, condoms, co-trimoxazole, and HIV clinic referral. We analysed the CD4 distributions from a district hospital cohort, campaign participants and from the 2007 Kenya Aids Indicator Survey (KAIS). Of the 5198 individuals participating in the campaign, all received HTC, 329 (6.3%) tested positive, and 255 (5%) were newly diagnosed (median CD4 cell count 536 cells/μL). The hospital cohort and KAIS results included 1,284 initial CD4 counts (median 348/L) and 306 initial CD4 counts (median 550/μL), respectively (campaign and KAIS CD4 distributionsP=0.346; hospital cohort distribution was lowerP<0.001andP<0.001). A Nyanza Province campaign strategy including ART <350 CD4 cell count could avert approximately 35,000 HIV infections and 1,240 TB cases annually. Community-based integrated public health campaigns could be a potential solution to reach universal access and Millennium Development Goals.

scholarly journals Occurrence of hypocortisolism in HIV patients: Is the picture changing?

2018 ◽  
Vol 52 (3) ◽  
pp. 147-152
Author(s):  
Iorhen E. Akase ◽  
Abdurazaq G. Habib ◽  
Adamu G. Bakari ◽  
Hamza Muhammad ◽  
Ibrahim Gezawa ◽  
...  
Keyword(s):  
Cell Count ◽  
Clinical Stage ◽  
Serum Cortisol ◽  
Cd4 Count ◽  
Laboratory Evaluation ◽  
Hiv Patients ◽  
Blood Samples ◽  
Cd4 Cell Count ◽  
Cortisol Levels ◽  
Cd4 Cell

Background: The occurrence of endocrine diseases in people who are infected with HIV is traditionally thought to occur in the setting of AIDS with opportunistic infections and malignancies. However, recent studies find the correlation between hypocortisolism and stage of HIV (CD4 count and WHO clinical stage) inconsistent.Methods: This descriptive cross-sectional study included three hundred and fifty (350) consecutive patients with HIV infection. They were interviewed, and subsequently underwent laboratory evaluation for the detection of hypocortisolism. Blood samples for serum cortisol estimation were taken at baseline and at 30 minutes following the administration of 1μg of tetracosactrin (Synacthen). In addition, the patients had blood samples taken at 0 minutes (baseline) for CD4+ lymphocyte cell counts.Results: At baseline, 108 (30.9%) participants had serum cortisol levels below 100 μg/L with a median value of 55.48 μg/L (11.36-99.96 μg/L), but only 57 (16.3%) study participants had stimulated serum cortisol levels below 180 μg/L with median of 118 μg/L (19.43-179.62). There was no significant difference in the occurrence of clinical features between participants with low and normal serum cortisol, nor WHO clinical stage, CD4 count and ART regimen. The occurrence of hypocortisolism was higher among participants who had been on ART for a longer period of time.Conclusion: There is a high prevalence of hypocortisolism among HIV patients by biochemical testing, especially those who have been on ARVs for a longer duration. Hypocortisolism cannot be predicted based on the participants’ WHO clinical stage of disease, CD4 cell count, or the treatment regimen.  Funding: Personal FundsKeywords: HIV, Adrenocortical insufficiency, CD4 cell count, Tetracosactrin

scholarly journals Prevalence and CD4 Cell Count Pattern of TB Co-infection Among HIV Infected Individuals In Nepal

2013 ◽  
Vol 10 (1) ◽  
pp. 27-36
Author(s):  
Surya Raj Niraula ◽  
SP Barnawal ◽  
AK Agrahari ◽  
N Bista ◽  
DK Yadav ◽  
...  
Keyword(s):  
Cell Count ◽  
Hiv Infections ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
Cross Sectional ◽  
Cd4 Cell Count ◽  
Ciency Virus ◽  
Human Immunodefi Ciency Virus ◽  
One Year ◽  
Cd4 Cell

Background: Mycobacterium tuberculosis (TB) and Human Immunodefi ciency Virus (HIV) infections are two major public health problems in many parts of the world, particularly in developing counties like Nepal. The objective of the study is to find out prevalence and clinical presentation of the TB co-infection among HIV infected individuals and pattern of CD4 cell count in relation to types of TB and response of ART. Methodology: This is a cross-sectional study carried out in three VCT clinics from Dharan and Kathmandu from April 2010 to March 2011. The appropriate samples, 313 HIV individuals were taken as study sample. Results: The study revealed that more than 36% of individuals were co-infected with TB. Among them, nearly 65% had pulmonary TB, more than one-forth had gland TB. There is signifi cant association of TB co-infection among male compared to females (P=0.021). Fever, weight loss and cough were found to have signifi cant symptoms associated with TB-HIV co-infection. The average CD4 count among TB co-infected population was signifi cantly less compared to uninfected ones just before starting ART (P=0.022) and even after six months (P=0.001). After one year of ART continuation, there was no signifi cant association on average CD4 count among the two groups. But then, the mean CD4 count became more in TB co-infected individuals compared to those who had no TB co-infection. Conclusion: TB-HIV co-infection is an emerging medical issue in Nepal. More than one third of HIV patients are co-infected with TB. Consideration of TB need to be made while caring patients with HIV infection and vice versa. ART plays very important role in increasing CD4 cell count among TB-HIV coinfected patients. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2013; X(1); 27-36 DOI: http://dx.doi.org/10.3126/saarctb.v10i1.8674

Sign in / Sign up

Export Citation Format

Share Document