scholarly journals Immunological outcomes after six months with first line antiretroviral therapy: a lesson from Yogyakarta, Indonesia

2018 ◽  
Vol 12 (05) ◽  
pp. 385-389
Author(s):  
Mardy Pangarungan ◽  
Eggi Arguni
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Cd4 T Cell ◽  
First Line ◽  
Cd4 Cell Count ◽  
Immunological Status ◽  
Art Initiation ◽  
Cell Percentage ◽  
Cd4 Cell ◽  
Absolute Cell Count

Introduction: More than 1,300 children aged 0-14 years were infected with HIV in Indonesia by 2016. Adequate antiretroviral therapy (ART) can increase nutritional and immunological status, reduce incidence of opportunistic infection and mortality caused by HIV infection. After ART initiation, the children’s treatment response needs to be monitored with CD4+ cell count and Viral Load (VL) evaluation. In resource-limited setting, clinical and immunological parameters can be used to evaluate ART outcomes. The aimed of this study to know immunological status of the patient after 6 months ART in Dr. Sardjito Hospital in Yogyakarta, Indonesia. Methodology: A retrospective study was conducted from January 2010 to May 2016. HIV-infected children aged 0-18 years who were given first-line ART at least 6 months were included in this study. Age when ART initiation, gender, residence, nutritional status, clinical staging based on WHO criteria, incidence of hospitalization, baseline CD4+ cell count and CD4+ cell count after 6 months of therapy, tuberculosis treatment, and ART regimens were collected from medical records. Data were entered and analyzed using SPSS version 20.0 Results: Thirty-five subjects were included in this study. Median CD4+ T cell percentage increased from 3.16 (IQR 1-18) % to 11.0 (IQR 2-32) %, whereas median CD4+ absolute cell count increased from 9.5 (IQR 3-176) cell/mm3 to 419.5 (IQR 202-1428) cell/mm3. Conclusion: Immunologic conditions could improve even with very low levels of CD4+ T cell percentage and CD4+ absolute cell count. Monitoring immunologic conditions and adherence of children with ART are essential to improve treatment outcomes.

scholarly journals Risk factors for discordant immune response among HIV-infected patients initiating antiretroviral therapy: A retrospective cohort study

2012 ◽  
Vol 13 (4) ◽  
pp. 168 ◽  
Author(s):  
B P Muzah ◽  
S Takuva ◽  
M Maskew ◽  
S Delany-Moretlwe
Keyword(s):  
Immune Response ◽  
Antiretroviral Therapy ◽  
Cell Count ◽  
Retrospective Cohort ◽  
Viral Suppression ◽  
Cd4 Cell Count ◽  
Logistic Regression Models ◽  
Art Initiation ◽  
Patients Experience ◽  
Cd4 Cell

Background. The therapeutic goal of antiretroviral therapy (ART) is sustained immune recovery and viral suppression. However, some patients experience poor CD4 cell count responses despite achieving viral suppression. Such discordant immune responses have been associated with poor clinical outcomes. Objective. We aimed to determine the prevalence of discordant immune response and explore associated factors in a retrospective cohort of patients attending 2 large public sector clinics, during the 6 months following ART initiation. Methods. Data were analysed from 810 HIV-infected adults initiated on first-line ART at 2 clinics in Johannesburg, between 1 November 2008 and 31 December 2009. Multivariate logistic regression models were used to estimate adjusted odds ratios (AORs) to determine associations between discordant immune response and clinical and demographic factors. Results. At ART initiation, 65% (n=592) of participants were female, with a mean age of 38.5 years. Median baseline CD4 cell count was 155 cells/mm3, 70% (n=645) of patients had a haemoglobin level >11 g/dl and 88% (n=803) were initiated on stavudine-lamivudine-efavirenz/nevirapine (D4T-3TC-EFV/NVP). Six months after ART initiation, 24% (n=220) of patients had a discordant immune response and 7% (n=67) a discordant virological response. On multivariate analysis, baseline CD cell count ≥200 cells/mm3 (AOR 3.02; 95% confidence interval (CI) 2.08 - 4.38; p

Reasons for delayed antiretroviral therapy (ART) initiation in the era of early ART initiation guidelines: a retrospective service evaluation

2019 ◽  
Vol 30 (4) ◽  
pp. 415-418 ◽  
Author(s):  
Ming J Lee ◽  
Serena Venturelli ◽  
Wayne McKenna ◽  
Jhia Teh ◽  
Ojali Negedu ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Linkage To Care ◽  
Service Evaluation ◽  
Hiv Diagnosis ◽  
Cd4 Cell Count ◽  
Median Baseline ◽  
Art Initiation ◽  
Cell Counts ◽  
Cd4 Cell

Following changes in national antiretroviral therapy (ART) guidelines removing the CD4 threshold for initiation of ART, we evaluated the time to ART initiation and reasons for delayed or non-initiation. A retrospective notes review of 292 newly diagnosed HIV-positive individuals attending two London clinics between August 2015 and December 2016 was performed. Two hundred and fifty-four of 292 (87%) individuals started ART. Median time to ART initiation was 29 days (range: 0–514). Thirty of 292 (13%) did not start ART. Rates of virological suppression at six months were similar regardless of time to ART initiation. People who inject drugs (16.7% vs. 3.6%) (p = 0.009), having a higher median baseline CD4 cell count (500 vs. 388 cells/mm3, p = 0.001), and having gastrointestinal/liver co-morbidities (23% vs. 9%, p = 0.001) were associated with delayed ART initiation. The cohort not on ART had a higher median baseline CD4 cell count (500 vs. 388 cells/mm3, p < 0.001). Documented reasons for delayed or ART non-initiation included patient’s choice, prolonged adjustment periods, and difficulty leaving work. We conclude that delayed or non-initiation of ART was associated with injecting drug use and prolonged adjustment to a new HIV diagnosis. Clinician factors may include lack of urgency with higher baseline CD4 cell counts. Improved linkage to care and drug services pathways may encourage timely ART initiation.

scholarly journals Couples HIV testing and immediate antiretroviral therapy for serodiscordant HIV-positive partners: Translating evidence into programme in Vietnam

2019 ◽  
Vol 30 (8) ◽  
pp. 739-747 ◽  
Author(s):  
Duong D Bui ◽  
Nhan T Do ◽  
Linh TT Pham ◽  
Patrick Nadol ◽  
Van TT Nguyen ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Drug Use ◽  
Hiv Testing ◽  
Cell Count ◽  
Viral Suppression ◽  
Consistent Condom ◽  
Hiv Positive ◽  
Cd4 Cell Count ◽  
Art Initiation ◽  
Cd4 Cell

Injection drug use and heterosexual transmission from male key populations to their female partners have been the dominant modes of HIV transmission in Vietnam. A demonstration project was conducted to offer immediate antiretroviral therapy (ART) (regardless of CD4 cell count) to HIV-seropositive partners in serodiscordant couples. During March–December 2013, couples HIV testing and counselling (HTC) and immediate ART were offered in two drug use-affected provinces. Of 256 couples receiving couples HTC, 146 (57%) were serodiscordant; 134 (92%) seropositive partners initiated ART irrespective of CD4 cell count. Of these, 86% were male; 57% reported ever using illicit drugs; median CD4 cell count before ART initiation was 374 cells/mm3. Consistent condom use was reported by 58, 70 and 71% among HIV-positive partners at months 0, 3 and 12. At 12 months after ART initiation, 119 (89%) HIV-positive partners were retained in care; 96 (95% of those tested) achieved viral suppression (<1000 copies/ml). Uptake of immediate ART and viral suppression among those initiating ART were high, paving the way for ART regardless of CD4 cell count as national policy in Vietnam.

Virological failure in children living with HIV on antiretroviral therapy: correlates and predictive value of clinical measurements and CD4 cell count

2019 ◽  
Vol 30 (12) ◽  
pp. 1207-1213
Author(s):  
Laura P Newman ◽  
Jade Pagkas-Bather ◽  
Anne Njoroge ◽  
Dalton Wamalwa ◽  
Ruth Nduati ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Virological Failure ◽  
Hiv Diagnosis ◽  
Hiv Viral Load ◽  
Cd4 Cell Count ◽  
Immunological Monitoring ◽  
Art Initiation ◽  
Living With Hiv ◽  
Cd4 Cell

Clinical correlates and CD4 cell count are used to predict HIV virological failure among children living with HIV in resource-limited settings, but there are limited data on their prediction of treatment failure compared to viral measurement. Using HIV viral load as a gold standard, sensitivity and specificity of longitudinal CD4 responses and clinical changes were defined in children living with HIV on antiretroviral therapy (ART) for ≥6 months in Kenya. Prevalence and correlates of virological failure were determined using log-binomial regression with robust standard error. Among 223 children who were followed for 12 months, median age in years at HIV diagnosis, ART initiation, and study enrollment were 3.3, 3.6, and 7.5, respectively. Older children at HIV diagnosis and ART initiation were less likely to experience virological failure. Immunological and clinical failure had low sensitivity (0 and 2%, respectively) to identify virological failure. Among those with virological failure, there was no indication from immunological markers and only two (2%) indicated with clinical markers. Clinical and immunological monitoring of HIV were insensitive and poor predictors of virological failure, emphasizing the importance of routine virological monitoring to inform ART treatment decisions for children living with HIV.

scholarly journals Impact of Baseline HIV-1 Tropism on Viral Response and CD4 Cell Count Gains in HIV-Infected Patients Receiving First-line Antiretroviral Therapy

2011 ◽  
Vol 204 (1) ◽  
pp. 139-144 ◽  
Author(s):  
E. Seclen ◽  
V. Soriano ◽  
M. M. Gonzalez ◽  
L. Martin-Carbonero ◽  
H. Gellermann ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
First Line ◽  
Cd4 Cell Count ◽  
Viral Response ◽  
Cd4 Cell ◽  
Hiv 1

Failure to achieve a CD4+ cell count response on combination antiretroviral therapy despite consistent viral load suppression

AIDS ◽  
2014 ◽  
Vol 28 (6) ◽  
pp. 919-924 ◽  
Author(s):  
Jemma L. O’Connor ◽  
Colette J. Smith ◽  
Fiona C. Lampe ◽  
Teresa Hill ◽  
Mark Gompels ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Cell Count ◽  
Combination Antiretroviral Therapy ◽  
Viral Load Suppression ◽  
Cd4 Cell Count ◽  
Count Response ◽  
Cd4 Cell

scholarly journals Current CD4 Cell Count and the Short‐Term Risk of AIDS and Death before the Availability of Effective Antiretroviral Therapy in HIV‐Infected Children and Adults

2008 ◽  
Vol 197 (3) ◽  
pp. 398-404 ◽  
Author(s):  
David Dunn ◽  
Patrick Woodburn ◽  
Trinh Duong ◽  
Julian Peto ◽  
Andrew Phillips ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Cell Count ◽  
Short Term ◽  
Cd4 Cell Count ◽  
Cd4 Cell
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