Evaluation of early immunological response among patients on first line highly active anti-retroviral therapy (HAART) at Kenyatta National Hospital

Abstract

Objective: Introduction of highly active antiretroviral therapy in 1996 has revolutionized the care of patients infected with HIV. Complete viral suppression in patients on HAART results in immunological response evidenced by an increase in CD4+ T-cell count. Early good immunological response to anti­retroviral therapy portends good clinical outcome in AIDS patients. The use of first line HAART has been scaled up in this country but there is paucity of data on immunological response to such therapies. This study evaluated early immunological response among patients on first line HAART attending to CCC at KNH between the year 2003 and June 2007. Methodology: This was a retrospective analytical study conducted among patients on first line HAART attending the CCC at Kenyatta National Hospital. A list of files of all patients on first line HAART was obtained from CCC pharmacy and Demographic data, baseline CD4+ T- count and CD4+ T- cell count at six months of treatment extracted from files that met our inclusion criteria. CD4+ cell change was used to assess Immunological response with good response being defined as a change in CD4+ cell count of 50 cells /rnm" or more from the baseline level at six months. Data was analyzed using SPSS version 15.0. Results: One thousand six hundred and seventy-eight patients were on first line therapy within the study duration. Out of these, 780 patients did not meet the inclusion criteria while 98 files could not be retrieved from the records department leaving 800 patients for analysis. The study had more females than males with male to female ratio of 1: 1.4. the mean age for the group was 38.1 years with median of 37years. Fifty seven percent of patients were in WHO stage three. The mean baseline CD4+ cell count was 127.2 cells/ mrrr' while mean CD4+ cell count at six months of therapy was 239.81 cells /rnm". Good immunological response was recorded in 77.6% of the study population and this was not influenced by demographic factors namely age and sex. CD4+ T- cell count at six months was significantly associated with baseline CD4+ cell count with an R - square of 0.62 at95% mean prediction interval on linear regression. Conclusion: This study demonstrated good immunological response among patients on first line HAART in Kenyatta National Hospital. Therefore, first line HAART regimen currently in use (stavudina, lamivudine and nevirapine or efavirenz) is effective if immunological response alone is considered. This study has also demonstrated the utility of Baseline CD4+ count in predicting CD4+ T cell count at six months of therapy.