Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans
Sarah Nanzigu,1,2 Ronald Kiguba,1 Joseph Kabanda,3 Jackson K Mukonzo,1 Paul Waako,1 Cissy Kityo,4 Fred Makumbi31Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; 3...
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Dove Medical Press
2013
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oai:doaj.org-article:8c6733e8cddb4c2da21419292ab0f73d2021-12-02T06:15:27ZPoor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans1179-1373https://doaj.org/article/8c6733e8cddb4c2da21419292ab0f73d2013-12-01T00:00:00Zhttp://www.dovepress.com/poor-immunological-recovery-among-severely-immunosuppressed-antiretrov-a15215https://doaj.org/toc/1179-1373Sarah Nanzigu,1,2 Ronald Kiguba,1 Joseph Kabanda,3 Jackson K Mukonzo,1 Paul Waako,1 Cissy Kityo,4 Fred Makumbi31Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; 3Institute of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; 4Joint Clinic Research Centre, Kampala, UgandaIntroduction: CD4 T lymphocytes remain the surrogate measure for monitoring HIV progress in resource-limited settings. The absolute CD4 cell counts form the basis for antiretroviral therapy (ART) initiation and monitoring among HIV-infected adults. However, the rate of CD4 cell change differs among patients, and the factors responsible are inadequately documented.Objective: This study investigated the relationship between HIV severity and ART outcomes among ART-naïve Ugandans, with the primary outcome of complete immunological recovery among patients of different baseline CD4 counts.Methods: Patients' records at two HIV/ART sites – the Joint Clinic Research Centre (JCRC) in the Kampala region and Mbarara Hospital in Western Uganda – were reviewed. Records of 426 patients – 68.3% female and 63.2% from JCRC – who initiated ART between 2002 and 2007 were included. HIV severity was based on baseline CD4 cell counts, with low counts considered as severe immunosuppression, while attaining 418 CD4 cells/µL signified complete immunological recovery. Incidence rates of complete immunological recovery were calculated for, and compared between baseline CD4 cell categories: <50 with ≥50, <100 with ≥100, <200 with ≥200, and ≥200 with ≥250 cells/µL.Results: The incidence of complete immunological recovery was 158 during 791.9 person-years of observation, and patients with baseline CD4 ≥ 200 cells/µL reached the end point of immunological recovery 1.89 times faster than the patients with baseline CD4 < 200 cells/µL. CD4 cell change also differed by time, sex, and site, with a faster increase observed during the first year of treatment. CD4 cell increase was faster among females, and among patients from Mbarara.Conclusion: Initiating ART at an advanced HIV stage was the main reason for poor immunological recovery among Ugandans. Earlier ART initiation might lead to better immunological responses.Keywords: baseline CD4 cells, HIV severity, immunological recovery, ART outcome, ARTNanzigu SKiguba RKabanda JMukonzo JKWaako PKityo CMakumbi FDove Medical PressarticleImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol 2013, Iss default, Pp 309-319 (2013) |
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DOAJ |
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EN |
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Immunologic diseases. Allergy RC581-607 |
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Immunologic diseases. Allergy RC581-607 Nanzigu S Kiguba R Kabanda J Mukonzo JK Waako P Kityo C Makumbi F Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans |
| description |
Sarah Nanzigu,1,2 Ronald Kiguba,1 Joseph Kabanda,3 Jackson K Mukonzo,1 Paul Waako,1 Cissy Kityo,4 Fred Makumbi31Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; 3Institute of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; 4Joint Clinic Research Centre, Kampala, UgandaIntroduction: CD4 T lymphocytes remain the surrogate measure for monitoring HIV progress in resource-limited settings. The absolute CD4 cell counts form the basis for antiretroviral therapy (ART) initiation and monitoring among HIV-infected adults. However, the rate of CD4 cell change differs among patients, and the factors responsible are inadequately documented.Objective: This study investigated the relationship between HIV severity and ART outcomes among ART-naïve Ugandans, with the primary outcome of complete immunological recovery among patients of different baseline CD4 counts.Methods: Patients' records at two HIV/ART sites – the Joint Clinic Research Centre (JCRC) in the Kampala region and Mbarara Hospital in Western Uganda – were reviewed. Records of 426 patients – 68.3% female and 63.2% from JCRC – who initiated ART between 2002 and 2007 were included. HIV severity was based on baseline CD4 cell counts, with low counts considered as severe immunosuppression, while attaining 418 CD4 cells/µL signified complete immunological recovery. Incidence rates of complete immunological recovery were calculated for, and compared between baseline CD4 cell categories: <50 with ≥50, <100 with ≥100, <200 with ≥200, and ≥200 with ≥250 cells/µL.Results: The incidence of complete immunological recovery was 158 during 791.9 person-years of observation, and patients with baseline CD4 ≥ 200 cells/µL reached the end point of immunological recovery 1.89 times faster than the patients with baseline CD4 < 200 cells/µL. CD4 cell change also differed by time, sex, and site, with a faster increase observed during the first year of treatment. CD4 cell increase was faster among females, and among patients from Mbarara.Conclusion: Initiating ART at an advanced HIV stage was the main reason for poor immunological recovery among Ugandans. Earlier ART initiation might lead to better immunological responses.Keywords: baseline CD4 cells, HIV severity, immunological recovery, ART outcome, ART |
| format |
article |
| author |
Nanzigu S Kiguba R Kabanda J Mukonzo JK Waako P Kityo C Makumbi F |
| author_facet |
Nanzigu S Kiguba R Kabanda J Mukonzo JK Waako P Kityo C Makumbi F |
| author_sort |
Nanzigu S |
| title |
Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans |
| title_short |
Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans |
| title_full |
Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans |
| title_fullStr |
Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans |
| title_full_unstemmed |
Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans |
| title_sort |
poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve ugandans |
| publisher |
Dove Medical Press |
| publishDate |
2013 |
| url |
https://doaj.org/article/8c6733e8cddb4c2da21419292ab0f73d |
| work_keys_str_mv |
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