Sub-optimal CD4 reconstitution despite viral suppression in an urban cohort on Antiretroviral Therapy (ART) in sub-Saharan Africa: Frequency and clinical significance
2008

CD4 Recovery Issues in HIV Patients on ART in Africa

Sample size: 559 publication Evidence: moderate

Author Information

Author(s): Nakanjako Damalie, Kiragga Agnes, Ibrahim Fowzia, Castelnuovo Barbara, Kamya Moses R, Easterbrook Philippa J

Primary Institution: Infectious Diseases Institute, Makerere University, Kampala, Uganda

Hypothesis

Patients with suboptimal CD4 reconstitution are at increased risk of clinical events.

Conclusion

The frequency of suboptimal CD4 reconstitution is high in sub-Saharan Africa, but rates of AIDS-related clinical events were not higher in those with suboptimal CD4 reconstitution.

Supporting Evidence

  • 21% of patients had suboptimal CD4 reconstitution at 6 months.
  • Majority of patients with suboptimal CD4 at 6 months maintained this status up to 2 years.
  • No significant differences in clinical events were found between patients with and without suboptimal CD4 reconstitution.

Takeaway

Some people taking HIV medicine don't get enough immune cells back, even when the virus is under control. This can be a problem, but it doesn't always lead to more sickness.

Methodology

Data from a prospective cohort of 559 patients initiating ART was analyzed to determine the frequency and predictors of suboptimal CD4 reconstitution.

Potential Biases

Potential biases may arise from the observational nature of the study and the specific patient population at a single facility.

Limitations

The study was limited to patients with sustained HIV-RNA viral suppression, which may not represent all patients on ART.

Participant Demographics

Of 559 patients, 69% were female, with a median age of 38 years and a median CD4 count of 98 cells/μl at baseline.

Digital Object Identifier (DOI)

10.1186/1742-6405-5-23

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