Association of Pre-Antiretroviral Treatment Body Mass Index with CD4+ T-lymphocyte Immune Reconstitution among HIV-Infected Adults and Adolescents Initiated on Antiretroviral Treatment: A Retrospective Longitudinal Study

Abstract

Human immunodeficiency virus (HIV) infection, causes acquired immune deficiency syndrome (AIDS) condition which is the world’s leading pandemic that causes millions of deaths each year. HIV has no cure, infected patients rely on effective management with the use of antiretroviral treatment to ensure suppression of viral replication, increase of CD4+ T-lymphocyte cells and increased time to disease progression, so that people living with HIV can enjoy health lives and reduce the risk of transmitting the virus to others. CD4+ count monitoring is an essential tool for initiating and monitoring of antiretroviral treatment and is greatly used in developing countries where Kenya is included. CD4+ response is dependent on; environmental setting where treatment is being offered, individual and population characteristics that include; adherence, age, gender, baseline CD4+ cell count, baseline viral load and the individuals Basal Metabolic Index (BMI) which is a measure of the patients nutritional status and is estimated as weight divided by height-squared (kg/m2). This study attempts to provide a more recent, updated and clear association of these variables that independently predict patient’s CD4+ immune reconstitution. This is a retrospective longitudinal study of ART-naïve, HIV-infected adults and adolescents initiated on standard first line Anti-Retroviral Treatment regimen and their CD4+ response followed up for 18 months. Study population included adults and adolescents registered and initiated on standard first line Anti-Retroviral Treatment regimen, as part of routine comprehensive care program of the Kenyan Government in conjunction with donor partners; USAID, ICAP and EGPAF at Masaba-North SubCounty PSC/CCC. Statistical Analysis was done using multilevel mixed effect linear models in STATA to analyze the BMI categories CD4+ level intercept values and other variables coefficients and compare them to their reference groups to obtain P values. Repeated measures Analysis of variance was also used to determine if there a difference in CD4+ mean response between the four intervals of measurement. Results from the study indicate that BMI is an independent predictor of CD4+ lymphocyte cells immune reconstitution for patients on antiretroviral treatment. While Age, Gender, and Number of ART interruptions were statistically significant when other variables were accounted for in the model over the 18 months of follow up. Whereas baseline BMI and WHO clinical stage were less statistically significant.