Generic placeholder image

Anti-Infective Agents

Author(s): Olayemi Balogun, Bukhari Isah Shuaib, Usman Abdulrasheed Usman* and Aminu Abba Yusuf

DOI: 10.2174/1573404819666220602110733

DownloadDownload PDF Flyer Cite As
Impact of Viral Load Suppression on CD4 + T-cell Count and BMI Following Combine Antiretroviral Therapy (cART) in HIV-1 Infected Individuals: Preliminary Findings in a Resource Poor Setting

Article ID: e020622205560 Pages: 10

  • * (Excluding Mailing and Handling)

Abstract

Background: Immunological CD4+ T cell gain is representative of an effective response to combined antiretroviral therapy (cART) in HIV-infected persons. Nevertheless, baseline clinical and socio-demographic factors are significant moderators of this response.

Objective: This study investigates the impact of viral suppression on immune reconstitution and body mass index (BMI) following ART initiation in Zaria, a resource-poor subpopulation in Northwestern Nigeria.

Methods: A hospital-based prospective study was conducted among 44 cART-naïve HIVpositive individuals. BMI, CD4 counts, and viral load were measured using standard methods at baseline and six months after initiation of cART.

Results: There was no significant difference in the CD4+ T-cell count at baseline and 6 months on cART along with the different categories (C: < 200 cells/mm3, B: 200-499 cell/mm3, A: >500 cell/mm3). However, ~90% of subjects in category C had immunological failure 6 months on cART. The number of subjects with viral copies < 1000/ml at baseline was 7(16%), while at 6 months on cART, the number increased to 35(80%), P<0.05. Viral suppression (VL copies <1000/ml) was significantly correlated with immune recovery (CD4 count > 200 cell/mm3) in obese individuals (P<0.02). There was a significant association between subjects with CD4+ count < 200 cells/mm3 after 6 months on ART and having baseline VL copies of <1000/ml and low BMI (aOR 2.2 and 2.4 respectively, p≤0.05).

Conclusion: Findings from this study suggest a high prevalence of paradoxical VL suppression but not immune CD4 gain in the studied subjects following cART. Larger studies are needed to corroborate these findings.

Keywords: CD4+ T-cell count, Viral Load, BMI, ART, HIV-1

Graphical Abstract

[1]
Global Health Observatory. HIV/AIDS global situation trends [webpage on the Internet]. Available from: http://www.who.int/gho/hiv/en/
[2]
Caldwell, J.C.; Orubuloye, I.O.; Caldwell, P. Underreaction to AIDS in Sub-Saharan Africa. Soc. Sci. Med., 1992, 34(11), 1169-1182.
[http://dx.doi.org/10.1016/0277-9536(92)90310-M] [PMID: 1641678]
[3]
Deeks, S.G.; Overbaugh, J.; Phillips, A.; Buchbinder, S. HIV infection. Nat. Rev. Dis. Primers, 2015, 1(1), 15035.
[http://dx.doi.org/10.1038/nrdp.2015.35] [PMID: 27188527]
[4]
Joint United Nations programme on HIV/AIDS. Sub-Saharan African., 2018. Available from: http: www.unaids.org/en/countryresponses
[5]
National agency for the control of AIDS (2017). National Strategic Plan (NSP), 2017. Available from: https://naca.gov.ng/wp-content/uploads/2018/05/National-HIV-and-AIDS-Strategic-Plan-FINAL1.pdf
[6]
Alebel, A.; Demant, D.; Petrucka, P.; Sibbritt, D. Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect. Dis., 2021, 21(1), 1.
[http://dx.doi.org/10.1186/s12879-020-05706-z] [PMID: 33390160]
[7]
Crum-Cianflone, N.F.; Roediger, M.; Eberly, L.E.; Ganesan, A.; Weintrob, A.; Johnson, E.; Agan, B.K. Impact of weight on immune cell counts among HIV-infected persons. Clin. Vaccine Immunol., 2011, 18(6), 940-946.
[http://dx.doi.org/10.1128/CVI.00020-11] [PMID: 21525303]
[8]
Johnson, K.D.; Cai, B.; Duffus, W.; White, K.; Smieja, M.; Divya, A.; Merchant, A.T. Longitudinal association between BMI at diagnosis and HIV disease progression. AIDS Behav., 2014, 18(11), 2249-2257.
[http://dx.doi.org/10.1007/s10461-014-0805-0] [PMID: 24880700]
[9]
Li, X.; Ding, H.; Geng, W.; Liu, J.; Jiang, Y.; Xu, J.; Zhang, Z.; Shang, H. Predictive effects of body mass index on immune reconstitution among HIV-infected HAART users in China. BMC Infect. Dis., 2019, 19(1), 373.
[http://dx.doi.org/10.1186/s12879-019-3991-6] [PMID: 31046702]
[10]
Obiri-Yeboah, D.; Pappoe, F.; Baidoo, I.; Arthur, F.; Hayfron-Benjamin, A.; Essien-Baidoo, S.; Kwakye-Nuako, G.; Ayisi Addo, S. Immunologic and virological response to ART among HIV infected individuals at a tertiary hospital in Ghana. BMC Infect. Dis., 2018, 18(1), 230.
[http://dx.doi.org/10.1186/s12879-018-3142-5] [PMID: 29783953]
[11]
Margaret, C. Comparison of viral load and cd4+ values of ARV naïve and ARV challenged HIV patients in taraba state Nigeria. Microbiol Infect Dis., 2018, 2(2), 1-10.
[12]
Stafford, K.A.; Odafe, S.F.; Lo, J.; Ibrahim, R.; Ehoche, A.; Niyang, M.; Aliyu, G.G.; Gobir, B.; Onotu, D.; Oladipo, A.; Dalhatu, I.; Boyd, A.T.; Ogorry, O.; Ismail, L.; Charurat, M.; Swaminathan, M. Evaluation of the clinical outcomes of the test and treat strategy to implement treat all in Nigeria: Results from the Nigeria multi-center ART study. PLoS One, 2019, 14(7)e0218555
[http://dx.doi.org/10.1371/journal.pone.0218555] [PMID: 31291273]
[13]
Gregson, J.; Tang, M.; Ndembi, N.; Hamers, R.L.; Rhee, S-Y.; Marconi, V.C.; Diero, L.; Brooks, K.A.; Theys, K.; Rinke de Wit, T.; Arruda, M.; Garcia, F.; Monge, S.; Günthard, H.F.; Hoffmann, C.J.; Kanki, P.J.; Kumarasamy, N.; Kerschberger, B.; Mor, O.; Charpentier, C.; Todesco, E.; Rokx, C.; Gras, L.; Helvas, E.K.; Sunpath, H.; Di Carlo, D.; Antinori, A.; Andreoni, M.; Latini, A.; Mussini, C.; Aghokeng, A.; Sonnerborg, A.; Neogi, U.; Fessel, W.J.; Agolory, S.; Yang, C.; Blanco, J.L.; Juma, J.M.; Smit, E.; Schmidt, D.; Watera, C.; Asio, J.; Kurungi, W.; Tostevin, A.; El-Hay, T.; Clumeck, N.; Goedhals, D.; Van Vuuren, C.; Bester, P.A.; Sabin, C.; Mukui, I.; Santoro, M.M.; Perno, C.F.; Hunt, G.; Morris, L.; Camacho, R.; De Oliveira, T.; Pillay, D.; Schulter, E.; Murakami-Ogasawara, A.; Reyes-Terán, G.; Romero, K.; Avila-Rios, S.; Sirivichayakul, S.; Ruxrungtham, K.; Mekprasan, S.; Dunn, D.; Kaleebu, P.; Raizes, E.; Kantor, R.; Shafer, R.W.; Gupta, R.K. Global epidemiology of drug resistance after failure of WHO recommended first-line regimens for adult HIV-1 infection: A multicentre retrospective cohort study. Lancet Infect. Dis., 2016, 16(5), 565-575.
[http://dx.doi.org/10.1016/S1473-3099(15)00536-8] [PMID: 26831472]
[14]
Ceulemans, A.; Bouzahzah, C.; Prat, I.; Urassa, W.; Kestens, L. CD4-T cell enumeration in human immunodeficiency virus (HIV)-infected patients: A laboratory performance evaluation of Muse Auto CD4/CD4% system by World Health Organization prequalification of in vitro diagnostics. PLoS One, 2019, 14(1)e0209677
[http://dx.doi.org/10.1371/journal.pone.0209677] [PMID: 30673713]
[15]
HIV/AIDS Statistics and Surveillance. Division of HIV prevention, national center for HIV, viral Hepatitis, STD, and TB prevention centers for disease control and prevention; 2021 https://www.cdc.gov/hiv/basics/statistics.html
[16]
Shoko, C.; Chikobvu, D. A superiority of viral load over CD4 cell count when predicting mortality in HIV patients on therapy. BMC Infect. Dis., 2019, 19(1), 169.
[http://dx.doi.org/10.1186/s12879-019-3781-1] [PMID: 30770728]
[17]
Yang, X.; Su, B.; Zhang, X.; Liu, Y.; Wu, H.; Zhang, T. Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders. J. Leukoc. Biol., 2020, 107(4), 597-612.
[http://dx.doi.org/10.1002/JLB.4MR1019-189R] [PMID: 31965635]
[18]
Takuva, S.; Maskew, M.; Brennan, A.T.; Long, L.; Sanne, I.; Fox, M.P. Poor CD4 recovery and risk of subsequent progression to AIDS or death despite viral suppression in a South African cohort. J. Int. AIDS Soc., 2014, 17(1), 18651.
[http://dx.doi.org/10.7448/IAS.17.1.18651] [PMID: 24594114]
[19]
Kwakye-Nuako, G.; Boampong, J.N.; Dong, M.K.; Obiri-Yeboah, D.; Opoku, Y.K.; Sakyi, D.A. Modulation of cyptosporidiosis by CD4 levels in chronic diarrhoea HIV/AIDS individuals visiting Tarkwa Municipal Hospital, Ghana. Asian Pac. J. Trop. Dis., 2016, 6(10), 770-775.
[http://dx.doi.org/10.1016/S2222-1808(16)61127-1]
[20]
Eduardo, E.; Lamb, M.R.; Kandula, S.; Howard, A.; Mugisha, V.; Kimanga, D.; Kilama, B.; El-Sadr, W.; Elul, B. Characteristics and outcomes among older HIV-positive adults enrolled in HIV programs in four sub-Saharan African countries. PLoS One, 2014, 9(7)e103864
[http://dx.doi.org/10.1371/journal.pone.0103864] [PMID: 25075743]
[21]
Naidoo, K.; Yende-Zuma, N.; Augustine, S. A retrospective cohort study of body mass index and survival in HIV infected patients with and without TB co-infection. Infect. Dis. Poverty, 2018, 7(1), 35.
[http://dx.doi.org/10.1186/s40249-018-0418-3] [PMID: 29690932]
[22]
Erb, P.; Battegay, M.; Zimmerli, W.; Rickenbach, M.; Egger, M. Effect of antiretroviral therapy on viral load, CD4 cell count, and progression to acquired immunodeficiency syndrome in a community human immunodeficiency virus-infected cohort. Swiss HIV Cohort Study. Arch. Intern. Med., 2000, 160(8), 1134-1140.
[http://dx.doi.org/10.1001/archinte.160.8.1134] [PMID: 10789606]
[23]
Koethe, J.R.; Jenkins, C.A.; Lau, B.; Shepherd, B.E.; Silverberg, M.J.; Brown, T.T.; Blashill, A.J.; Anema, A.; Willig, A.; Stinnette, S.; Napravnik, S.; Gill, J.; Crane, H.M.; Sterling, T.R. Body mass index and early CD4 T-cell recovery among adults initiating antiretroviral therapy in North America, 1998-2010. HIV Med., 2015, 16(9), 572-577.
[http://dx.doi.org/10.1111/hiv.12259] [PMID: 25960080]
[24]
Chakravarty, J.; Sundar, S.; Chourasia, A.; Singh, P.N.; Kurle, S.; Tripathy, S.P.; Chaturbhuj, D.N.; Rai, M.; Agarwal, A.K.; Mishra, R.N.; Paranjape, R.S. Outcome of patients on second line antiretroviral therapy under programmatic condition in India. BMC Infect. Dis., 2015, 15(1), 517.
[http://dx.doi.org/10.1186/s12879-015-1270-8] [PMID: 26572102]
[25]
Lewis, J.; Payne, H.; Walker, A.S.; Otwombe, K.; Gibb, D.M.; Babiker, A.G.; Panchia, R.; Cotton, M.F.; Violari, A.; Klein, N.; Callard, R.E. Thymic output and CD4 T-Cell reconstitution in HIV-infected children on early and interrupted antiretroviral treatment: Evidence from the children with HIV early antiretroviral therapy trial. Front. Immunol., 2017, 8, 1162.
[http://dx.doi.org/10.3389/fimmu.2017.01162] [PMID: 28979264]
[26]
Bahemana, E.; Esber, A.; Dear, N.; Ganesan, K.; Parikh, A.; Reed, D.; Maganga, L.; Khamadi, S.; Mizinduko, M.; Lwilla, A.; Mkondoo, D.; Mwaisanga, G.; Somi, N.; Owouth, J.; Maswai, J.; Kiweewa, F.; Iroezindu, M.; Ake, J.A.; Crowell, T.A.; Valcour, V.G.; Polyak, C.S. Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study. AIDS Res. Ther., 2020, 17(1), 66.
[http://dx.doi.org/10.1186/s12981-020-00323-x] [PMID: 33183355]
[27]
Denue, B.A.; Ikunaiye, P.N.; Denue, C.B. Body mass index changes during highly active antiretroviral therapy in Nigeria. East. Mediterr. Health J., 2014, 19(Suppl. 3), S89-S97.
[PMID: 24995767]
[28]
Kong, Y.; Tian, Y.; Hao, Y.; Chong, X.; Xiao, J.; Yang, D.; Song, C.; Han, J.; Dai, G.; Zhang, F.; Zheng, H.; Zhao, H.; Zeng, H. Two types of poor immunological responder showing distinct responses to long-term HAART. Int. J. Infect. Dis., 2019, 86, 178-187.
[http://dx.doi.org/10.1016/j.ijid.2019.07.037] [PMID: 31398453]
[29]
Behzadi, P.; Gajdács, M. Writing a strong scientific paper in medicine and the biomedical sciences: A checklist and recommendations for early career researchers. Biol Futur., 2021, 72(4), 395-407.
[http://dx.doi.org/10.1007/s42977-021-00095-z] [PMID: 34554491]