EFFECT OF FIRST-LINE ANTIRETROVIRAL TREATMENT IN HIV-POSITIVE PATIENTS ON CD4 CELL COUNT RESPONSE IN BORU MEDA HOSPITAL, AMHARA

In limited resource countries, the effectiveness of first-line antiretroviral treatment in HIV-positive patients could be measured by its s trong predictor, the CD4 count for the ini tiation of antiretroviral therapy and proper management of disease progress. Even though, in addition to HIV, there are many factors which can influence the CD4 cell count considered to be constant. Methods : A retrospective cohort s tudy was conducted to examine the response of first-line antiretroviral treatment on CD4 count in HIV -positive patients at 0, 6, 12 and 24 months, who enrolled in the first month of 2013 and followed up to begining -2018.The covariance components model was employed to determine the CD4 count changes over time. Results: A total of 320 ART attendants were used to analyze their data. The majori ty 294(92.4%) of the respondents were started AZT based ART regimens, but there was no a significance difference among ART regimens for CD4 cell count. The mean baseline of CD4 cell count (166 cells/ mm3) was positive associated (p<0.001) with CD4 count increment at time of follow ups and was increased to 274 cells/mm3 significantly (p<0.001) at six months of initiation of ART. Working functional status and younger age, also contribute for CD4 count significant change. Conclusion: The change in CD4 count was high at the first 6 month than 12 and 24 month. All ART regimens without significance difference that increased mean CD4 count at the study period. Hence, i t can be concluded that ART is effective enough in improving the immune system and slowing the progression of HIV infection to AIDS.


INTRODUCTION
Human Immunodeficiency Virus (HIV) destroys specific cells of the body that defend the body against diseases are called CD4 cells [1,2]. HIV-positive patients with optimal antiretroviral therapy in the first 6-12 months in ARV naïve and adherent patient with drug susceptible virus, CD4 counts are increase by > 100 cells/mm 3 . Immunologic failure is indicated by a fall in CD4 counts higher than 50% from the peak value or a return to, or below, the pre-therapy baseline, or by persistent CD4 < 100 cells/mm 3 [3 ].
The CD4+ cell count thresholds for ART initiation were recently raised 350 to500 cells/ml in the United States, while from 200 to350 cells/ml in mid-and low-income countries [4].
The introduction of ART as a modality of treatment in HIV positives has resulted in a dramatic decrease in AIDS related morbidity and mortality and a great improvement in CD4 count of patients [5].
The aims of this study were to examine the relationship between patterns in CD4 count after initiation of combination antiretroviral treatment in HIV-infected patients.

Study design and period
A retrospective cohort study was conducted to assess the effect of ART on CD4 count among adult ART users enrolled in the first month of 2013 and followed up to begining -

Study area and population
The study was conducted at Bour meda Hospital (BMH) ART clinic, located in Dessie town, Amhara regional state, which is far 411 km, away from Addis Ababa the capital city of Ethiopia. The hospital gives ART initiation to the newly diagnosed HIV -infected patients after HIV testing with follow up treatment. The study population included HIV positive adults who initiated current first line ART treatment in the BMH.

Sample size and sampling procedure
All HIV positive adults who initiated ART in the hospital at study period and who had a complete CD4 count measurements at 0, 6, 12 and 24 months all were included. Therefore, 320 patients were taken.

Data collection procedures
The study completely used secondary data. Therefore, a data extraction check-list was adopts and modified the routinely collected data. A baseline WHO stage, functional Abebaw Tegegne Damtie EFFECT OF FIRST-LINE ANTIRETROVIRAL TREATMENT IN HIV-POSITIVE PATIENTS state, weight and CD4 count data were identified and collected from the registration documents of ART attendants which were collected from each patient at the initiation of ART. Subsequent CD4 count data were also taken from the same sources that were collected from each patient almost every 6 month. Similarly, other characteristics, like socio-demographic (sex and age) and initial regimen were also collected from the registration documents of patients. The data were entered, cleaned, and analyzed using SPSS version 20 statistical software. The CD4 count measurement just before the initiation of ART was considered as a covariate so that there should be at least one CD4 count reading that would be taken as a response variable after the initiation of ART.

Ethical considerations
Prior to study initiation, ethical clearance was obtained from Amhara public health institute. In addition, an official letter was written to BMH from Amhara Regional Health bureau and also permission was sought from BMH medical director to conduct the study. The confidentiality of data collected was maintained by omitting the Name and address of patient and prescriber.

Socio-demographic, Initial regimens, baseline clinical and immunological status of the respondents
A total of 320 HIV positive records were analyzed. The prevalence of age of study participants in the age group <35 years were 150(47.2%) and more than hafe 184 (57.9%) of them were initiated ART at WHO clinical stage III. Regarding the baseline CD4 cell count 102(32.1%) of the respondents were <100 cells/mm 3 . The majority 294(92.4%) of the respondents were started AZT based ART regimens. More than half of the respondents 198(62.3%) were female and most 246(77.4%) of them were Workable.

CD4 cell count changes after initiating ART
All ART regimens that improve the immune system, but there was no a significance difference among ART regimens for CD4 cell count increment. Sex and Baseline weight also there was not statically significance.      [10,11], had also better response to ART [12], repeated -testing, and acceptance of linkage to HIV-care after a positive result as compared to males [13][14][15][16].
The CD4 count has been commonly used as the main treatment outcome signs for continuation of ART. The goal of ART is to achieve sustained viral suppression and increased CD4 counts in individuals on treatment. CD4 count measurements could affect by opportunistic infections at the start of ART and treatment period over time [20].
There was a significant (p<0.05) association between Baseline age and Cd4 counts at six month. At older baseline age the Cd4 count was decreased by -28.269 coefficients as compared to younger age. Different authors stated that younger age more reasoned out on CD4 cell recovery [21]. ART treatment response for older persons was poor [22] and come to the clinic late [23,24]. In contrast, other authors reported there was no any significance association between age and CD4 count increment [7, 20,21,25,26].

Limitations
In this paper some limitations that should be considered.

Conclusion
This study had shown, higher baseline CD4 count, contributed to great significant (p<0.001) increment of CD4 count. The change in CD4 count was high at the first 6 month than 12 and 24 month. Working functional status and younger age, also contribute for CD4 count change. All ART regimens without significance difference that increased mean cd4 count at the study period. Hence, it can be concluded that ART is effective enough in improving the immune system and slowing the progression of HIV infection to AIDS.