Revista de SIDA e investigación clínica

The immunological and clinical progress of adult HIV positive patients who were on antiretroviral therapy and follow-up for more than two years: Retrospective cohort study at University of Gondar Comprehensive Hospital.

Abstract

Mulualem Lemma*, Gezahegn Bewket, Amare Kifle, Yesuf Adem, Zegeye Getaneh, Yeshambel Belyhun, Takele Teklu

Introduction: Antiretroviral Therapy (ART) shows a great impact on immunological restoration and viral load suppression in individuals living with the Human Immune Deficiency Virus (HIV). Currently, among 38.4 million individuals living with HIV in the globe, around 28.7 million are under ART. Good adherence and follow-up of ART treatment decrease the morbidity and mortality rates of HIV positive individuals and increase the quality of life. Although it is a retrospective cohort study, we aimed to assess how ART regimens influence the restoration of immunological and hematological parameters, and the clinical progression after 2 and half years of ART treatment and follow-up.

Methodology: Retrospectively, we reviewed the medical records of HIV patients. Based on our follow-up requirements, we collected the medical records of 320 HIV patients retrospectively and followed them for 2 and half years. All the socio-demographic data with immunological, hematological, BIM, and clinical data of HIV patients under follow-up were collected every six months for 30 months period. Data were entered into SPSS version 23 and graph pad prism version 5.1 (graph pad software, San Diego, CA). The data were described and statistically analyzed with simple frequency and repeated measures of ANOVA.

Result: Among the 320 HIV patients who followed, 61.9% were females. In this study, The CD4 T cell count showed significant improvement from the baseline to the 12^th, 18^th, 24^th, and 30^th month follow-up; from the 6^th to 18^th, 24^th, and 30^th month follow-up, and from 12^th month to 24^th and 30^th month, indicating that ART significantly restored the immune response in HIV patients across the follow-up periods. The Body Mass Index (BMI) also showed similar significant improvement patterns with the CD4 T cell count. There was a significant improvement in the World Health Organization (WHO) clinical stage of HIV patients after follow-up as indicated by our result that the majority of HIV patients at baseline were at WHO stage III 168 (58.5%), however, after 2 and half year follow-up, only 16.3% remained at WHO stage III. In addition, at baseline (before initiation of ART), the proportion of HIV patients at WHO clinical stage I was only 12.8%, and that was increased to 44% at the end of the follow-up period. The burden of opportunistic infections also significantly decreased from 413.1% at baseline to 0.9% after follow-up. The hematological parameters such as total WBC count, platelet count, and hemoglobin levels were also significantly improved through the course of the follow-up periods.

Conclusion: Our study showed that good ART treatment and good follow-up of HIV management in patients with HIV can bring indispensable progress in their immunological, hematological, and clinical parameters.