Evaluation of CD4 count progression in HIV-infected patients on different classes of antiretroviral regimens

Abstract

Background: Understanding the expected effects of different antiretroviral regimens on CD4 count will guide therapeutic decision and monitoring treatment progress that will improve patients’ outcomes.

Objective: To evaluate the effects of two first line and one second line antiretroviral regimens on annual changes in CD4 count of HIV-infected patients at Usmanu Danfodiyo University Teaching Hospital, Sokoto.

Method: A retrospective analysis of patients’ records between 2011 and 2015 which were selected using systematic random sampling was conducted. A total of 423 records of patients that met the inclusion criteria were evaluated for changes in CD4 count. The data were analysed using descriptive, correlation and linear regression statistics, with p<0.05 considered statistically significant.

Results: Majority of the patients were females (75.4%) and their mean age was 37.1±9.1 years. Correlation analysis showed that increasing duration of the disease state (p=0.001) and treatment (p=0.001) were significantly associated with low annual percentage increase in CD4 count. Linear regression models showed that among patients with CD4 cell counts of ≤300 cells/mm³, the annual percentage increase of those on Tenofovir (TDF) + Emtricitabine (or Lamivudine) (XTC) + Efavirenz (EFZ), Zidovudine (AZT) + Lamivudine (3TC) + Nevirapine (NVP)and TDF+XTC + Lopinavir/ritonavir (LPV/r) regimens were 41.1%, 16.9% and 4.9% respectively. Patients with CD4 counts >300 to 500 cells/mm³ mostly had insignificant increase of 4.5%, 1.3% and 2.9% respectively. All patients with CD4 >500 cells/mm³ had insignificant decrease.

Conclusion: Significant increase in annual percentage CD4 count is observed only when the CD4 count is low with patients on TDF+XTC+EFZ regimen showing the best increase. Increase in duration of the disease and treatment were associated with low annual increase.

Keywords: Antiretroviral regimen, CD4 count, HIV, Highly active antiretroviral therapy