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 Modeling of the change in CD4 lymphocyte counts in patients before and after administration of the human immunodeficiency virus protease inhibitor indinavir.

1997 ◽  
Vol 41 (2) ◽  
pp. 449-453 ◽  
Author(s):  
D S Stein ◽  
G L Drusano
Keyword(s):  
Cell Count ◽  
Rate Constants ◽  
Half Life ◽  
Cd4 Cells ◽  
Cd4 Cell Count ◽  
Immunodeficiency Virus ◽  
The Mean ◽  
Cd4 Lymphocyte ◽  
Cd4 Cell ◽  
Cd4 Lymphocytes

We investigated the relationships between changes in CD4 lymphocytes counts over 24 weeks after the initiation of therapy with indinavir at dosages of > or = 2.4 g/day (n = 15) in human immunodeficiency virus-positive patients and compared them to the baseline values. Starting CD4 count were linked to the time-weighted average CD4 cell count (return) through a nonlinear effect model. The diminution of destruction of CD4 cells after the initiation of indinavir therapy was estimated by fitting simultaneous differential equations to the data by using a linked lymph node (LN)-blood (BL) (two-compartment) system in which there is a constant rate of generation (R), first-order transfer rate constants (KLN-BL and KBL-LN) of compartment exchange, and first-order rate constants of CD4 destruction in the absence and presence of indinavir (KLN-OUT1 and KLN-OUT2). The half-life of CD4 lymphocytes was calculated from the rate constants by standard two-compartment methods. The CD4 lymphocyte counts at the start and return were linked in a sigmoid-Emax model were the maximal effect (Emax) was at 574.6 cells/microliters and 50% of the effect occurred at 157.1 cells/microliters (r2 = 0.94; P < 0.001). The mean +/- standard deviation (median) KLN-OUT2 was 0.574 +/- 0.202 (0.589), indicating that indinavir decrease the destruction of CD4 cells by circa 41 to 42%. The mean (median) CD4 half-life was 11.5 +/- 5.72 day (10.3 days). In multivariate analysis, KLN-OUT2 was significantly correlated with starting the CD4 cells count and the change in the CD4 cell count on therapy. The relationship between CD4 lymphocyte half-life and the starting CD4 lymphocyte count was hyperbolic, with a rapid increase in half-life as the CD4 count decreased. On the basis of the calculated half-life, the average production (destruction) of CD4 lymphocytes was approximately 3 x 10(9) cells/day, with an individual variation of 44-fold. These findings suggest that (i) the CD4 lymphocyte cell count at the start is significantly correlated to both the decrease in the destruction rate of CD4 cells and the degree of change in the CD4 lymphocytes on therapy, (ii) the lower the initial CD4 lymphocyte count, the higher the amount of CD4 lymphocyte turnover and the lower the ability of the immune system to increase absolute CD4 lymphocyte levels after viral suppression, consistent with a decreased regenerative capacity with progression of disease; and (iii) the increase in CD4 lymphocytes is likely secondary to the expansion of proliferating pool of cells since our determinations are based on 24 weeks of effect.

scholarly journals To study the effect of various combinations of haart in CD4+ cell count in HIV patient at RIMS, Ranchi Art Centre

2017 ◽  
Vol 6 (4) ◽  
pp. 887
Author(s):  
Sumit Kumar Mahato ◽  
Uma Shanker Prasad Keshri ◽  
Akhilesh Kumar ◽  
Pholgu Protim ◽  
Vineet Kumar
Keyword(s):  
Cell Count ◽  
Hiv Infections ◽  
Cd4 Count ◽  
Monthly Interval ◽  
Cd4 Cell Count ◽  
Slowing Down ◽  
Highly Active ◽  
Hiv Epidemic ◽  
Cd4 Cell

Background: India has the third largest HIV epidemic in the world. In 2013, HIV prevalence in India was an estimated 0.3%, an estimated 130,000 people died from AIDS-related illnesses. Overall, India’s HIV epidemic is slowing down, with a 19% decline in new HIV infections (130,000 in 2013), and a 38% decline in AIDS-related deaths between 2005 and 2013. Antiretroviral therapy (ART) for the treatment of HIV infection has improved steadily since the advent of potent combination therapy in 1996. ART has dramatically reduced HIV-associated morbidity and mortality. The aim of this study is to see the change in CD4+ count in patient taking various combination of HAART (Highly active anti-retroviral treatment).Methods: A total of 215 patients were included in this study that came to the rims art centre for regular follow up and there cd4+ count at 6 monthly interval upto 18 months was taken and analysed.Results: The patients were evaluated for their change in CD4+ cell count. Mean of CD4+ count at 6 monthly interval was taken in this study which showed that haart combination causes significant improvement in cd4+ count in each group (1) stavudine, lamivudine, nevirapine (2)stavudine, lamivudine, efavirenz (3) zidovudine, lamivudine, nevirapine (4) zidovudine, lamivudine, efavirenz, (5) tenofovir, lamivudine, efavirenz.Conclusions: SLN combination was found most effective in increasing the CD4+ Cell count in comparision to the other combination. Other drugs combinations in decreasing order are as follows- SLE, ZLE, TLE, ZLN. 

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 24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

2019 ◽  
Author(s):  
Marc Harris Dassi Tchoupa Revegue ◽  
Elom Takassi ◽  
François Tanoh Eboua ◽  
Sophie Desmonde ◽  
Ursula Belinda Amoussou-Bouah ◽  
...  
Keyword(s):  
Cell Count ◽  
Cote D'ivoire ◽  
West African ◽  
Hiv Disclosure ◽  
Virological Suppression ◽  
Favorable Outcome ◽  
Cd4 Cell Count ◽  
Perinatally Acquired ◽  
Cd4 Cell

Abstract Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including timely disclosure of their HIV-serostatus that was explored in the West-African COHADO cohort. We assessed the 24-month outcomes in COHADO, among APHIV in relation to the disclosure of their own HIV-serostatus.Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. A favorable 24-month outcome was defined when combining being retained in care, without progression to WHO-AIDS stage, with CD4 cell count > baseline CD4 (± 10%) and with virological suppression (viral load [VL] <50 copies/mL). We investigated correlates of APHIV favorable 24-month outcome using multivariate logistic regression. Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); only 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01). Adjusted on sex, age, a 24-month favorable outcome was not associated with HIV-disclosure status but was significantly higher for APHIV living in Lomé compared to those living Abidjan (adjusted odds ratio =4.41, 95%CI:2.29-8.50). Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed accross countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.

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 Retention in Care among Patients with Early HIV Disease in Haiti

2017 ◽  
Vol 16 (6) ◽  
pp. 523-526 ◽  
Author(s):  
Kelly A. Hennessey ◽  
Taina Dadaille Leger ◽  
Vanessa R. Rivera ◽  
Adias Marcelin ◽  
Margaret L. McNairy ◽  
...  
Keyword(s):  
Cell Count ◽  
Retention In Care ◽  
Hiv Treatment ◽  
World Health ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Hiv Test ◽  
Lost To Follow Up ◽  
Cd4 Cell

In September 2015, the World Health Organization updated their guidelines to recommend antiretroviral therapy (ART) for all people living with HIV. Countries are now in the process of implementing strategies to provide universal HIV treatment. We analyzed the rate of retention and time to ART eligibility (according to 2013 WHO guidelines) among 3,345 adult patients receiving positive HIV test results between February 1, 2003 and March 31, 2013 at the GHESKIO Clinic in Haiti, with WHO stage 1 or 2 disease and initial CD4 cell count >500 cells/mm3. Among the 3,345 patients, 2,423 (72%) were female, the median age was 33 years, 3,089 (92%) lived in Port-au-Prince, and 1,944 (58%) had attended no school or primary school only. The median initial CD4 cell count was 668 cells/mm3 (IQR: 572-834); over the subsequent 2 years, 1,485 patients (44%) were lost to follow-up and 7 (<1%) died pre-ART, 1,041 (31%) were retained in pre-ART care, and 819 (24%) initiated ART. In multivariate analysis, secondary education (aOR 1.27; 95% CI: 1.10-1.47), female gender (aOR: 1.28; 95% CI: 1.09-1.50), co-habitation (aOR: 1.31; 95% CI: 1.09-1.57), and residence in Port-au-Prince (aOR: 1.43; 95% CI: 1.09-1.88) were associated with retention in care. The median time from baseline CD4 count to ART eligibility was 1.7 years. Prior to the implementation of universal treatment, pre-ART attrition was high among patients who did not qualify for ART at presentation. Though implementing WHO recommendations for universal ART will require service expansion, it will likely result in improved retention for those at risk of being lost to follow-up.

scholarly journals Effect of BMI and fat mass on HIV disease progression in HIV-infected, antiretroviral treatment-naïve adults in Botswana

2016 ◽  
Vol 115 (12) ◽  
pp. 2114-2121 ◽  
Author(s):  
S. S. Martinez ◽  
A. Campa ◽  
H. Bussmann ◽  
S. Moyo ◽  
J. Makhema ◽  
...  
Keyword(s):  
Cell Count ◽  
Disease Progression ◽  
Fat Mass ◽  
Antiretroviral Treatment ◽  
Obesity Paradox ◽  
Hiv Disease ◽  
Time To Event ◽  
Cd4 Cell Count ◽  
Cd4 Cell

AbstractAn obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings. This study investigated the relationship between overweight/obesity (BMI≥25 kg/m2) and HIV disease progression in HIV+ asymptomatic adults not on antiretroviral treatment (ART) in Botswana over 18 months. A cohort study in asymptomatic, ART-naïve, HIV+ adults included 217 participants, 139 with BMI of 18·0–24·9 kg/m2 and seventy-eight participants with BMI≥25 kg/m2. The primary outcome was time to event (≥25 % decrease in cluster of differentiation 4 (CD4) cell count) during 18 months of follow-up; secondary outcomes were time to event of CD4 cell count<250 cells/µl and AIDS-defining conditions. Proportional survival hazard models were used to compare hazard ratios (HR) on time to events of HIV disease progression over 18 months. Higher baseline BMI was associated with significantly lower risk of an AIDS-defining condition during the follow-up (HR 0·218; 95 % CI 0·068, 0·701; P=0·011). Higher fat mass at baseline was also significantly associated with decreased risk of AIDS-defining conditions during the follow-up (HR 0·855; 95 % CI 0·741, 0·987; P=0·033) and the combined outcome of having CD4 cell count≤250/µl and AIDS-defining conditions, whichever occurred earlier (HR 0·918; 95 % CI 0·847, 0·994; P=0·036). All models were adjusted for covariates. Higher BMI and fat mass among the HIV-infected, ART-naïve participants were associated with slower disease progression. Mechanistic research is needed to evaluate the association between BMI, fat mass and HIV disease progression.

scholarly journals Multilevel model on longitudinal data analysis in determinants of cd4 cell count among antiretroviral therapy attendant of hiv infected adults follow up in gondar teaching referral hospital, Gonder, Ethiopia.

2020 ◽  
Author(s):  
Kindu Kebede
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Multilevel Model ◽  
Immune Cell ◽  
Hemoglobin Level ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Cd4 Cell Count ◽  
Cd4 Cell

Abstract Background: Human immunodeficiency virus attacked an immune cell and the CD4 cell which is responsible for the body’s immune to infectious agents. Acquired immunodeficiency syndrome is one of the major public health problems in Sub-Saharan Africa including Ethiopia. The main objective of this study to identify the determinants of CD4 cell count among antiretroviral therapy attendants of infected adults follow up in Gonder teaching referral hospital, Gonder, Ethiopia implemented by SAS version 94. Methods: A retrospective cohort study was conducted on 216 regular follow up patients whose age greater than 14 years from December 1, 2012, to December 30, 2017. A multilevel model was used to identify the factors of CD4 cell count of patients and it considered variability between and within patients. Results: The mean with a standard deviation of weight, and a hemoglobin level of patients were 55.48(10.21), and 18.25(33.028) respectively. This study concluded that the variation for CD4 cell count existed between patients was 63 % and the remaining 37 % of variation existing within patients. In this study, the random coefficient time-varying covariate model was well fitted which shows weight and hemoglobin level were statistically significant predictors at a 5% level of significance for the log of CD4 cell count of patients. Conclusion: This study shows the hemoglobin level and weight of patients were statistically significant for the log of CD4 cell count of patients follow up in Gonder teaching referral hospital, Gonder, Ethiopia. Moreover, the result of the study shows that the log of CD4 count of patients increased when hemoglobin level and weight of patients increased. Hence, intervention should be given the ways to increase weight and hemoglobin levels of patients during follow up antiretroviral therapy.

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