Predictors of CD4 Count Changes after Initiation of Antiretroviral Treatment in University of Gondar Hospital, Gondar in Ethiopia

Background: The effort for preventing HIV/AIDS (Human Immune Deficiency Syndrome/Acquired Immune Deficiency Syndrome) ranges from behavioral intervention to introduction of antiretroviral Treatment (ART) program. ART has dramatically improved the livelihood of people living with HIV/AIDS. World Health Organization (WHO) recommends the optimum time for initiating ART should be guided by CD4 (Cluster Differentiation 4 ) count and clinical staging. Predictors of the change of CD4 count after initiation of ART are important for patient monitoring and AIDS prognosis prediction. This study aimed to investigate predictors of CD4 count change among patients on ART in University of Gondar Hospital, North West Ethiopia.

Methods: A cross sectional study was conducted among HIV/AIDS patients taking ART. A total of 2935 adults having at least two CD4 count values were included in the study. The study used both the ART data base and reviewed patient charts. The primary outcome measure was CD4 count change. Correlation and multiple linear regression analysis were used to identify predictors of CD4 count change.

Result and discussion: The median CD4 count has increased from 139 cells/ul at the initiation of ART to 356 cells/ul at the most recent visit. A median CD4 count change of 208 (IQR 224) cells/microliter was observed after 194.4(IQR 148.6) weeks on ART. The median rate of CD4+ T cell increase was 1.06 cells/week on ART. Age (β = 97.59, p=0.000), Baseline CD4 count (β = 0.222, p=0.000), hemoglobin level (β = 4.029, p=0.000) were significant predictors of CD4 count change. Patient’s functional status when commencing ART, WHO clinical stage, ART adherence status, cotrimoxasole adherence status, educational status, marital status were also found to be significant predictors of CD4 count change.

Conclusion: Age when starting ART, educational status, marital status, WHO clinical staging, baseline hemoglobin level, baseline CD4 count, ART adherence status, cotrimoxasole adherence status, functional status, and recent follow up CD4 are significant predictors of CD4 count change. Clinicians need to closely monitor patients who initiated ART at a lower baseline hemoglobin level, and/or CD4 count level.