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HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) INITIATION AND SHORT-TERM IMMUNE RESPONSE AMONG HIV-1-INFECTED PATIENTS IN CÔTE D'IVOIRE, SUB-SAHARAN AFRICA
S Diabaté, M Alary
Objective: to determine the predictors of CD4 count below 200/µl and to propose an algorithm for antiretroviral therapy initiation; and to assess the determinants of immune response to HAART in Côte d'Ivoire, sub-Saharan Africa.
Methods: 615 consecutive patients attending the largest HIV/AIDS day hospital were enrolled. We constructed a score system based on the results of a multivariate logistic regression analysis of the predictors of CD4 count <200/µl with the intention of proposing an algorithm able to accurately designate patients eligible for HAART. We also identified factors associated with a short-term gain >50 CD4/µl after HAART initiation.
Results: Total lymphocyte count (TLC) <1200 cells/µl (p<0.0001), each unit (1g/dl) decrease of haemoglobin (p<0.0001), and CDC clinical stages C (p=0.005) and B (p=0.045) as compared to stage A were associated with CD4 count <200/µl. Nonetheless, no accurate and clinically meaningful algorithm for eligibility to HAART was found. 303/615 patients were treated. The untreated patients did not meet the initiation criteria. 79.5% of the treated patients gained more than 50 CD4/µl after six months of HAART (median increase 128/µl). Adherence =>95% (p=0.022) and increase in absolute total lymphocyte count during follow-up (p<0.0001) were associated with a short-term positive immune response.
Conclusion: Even though TLC, haemoglobin and clinical stage systems have a predictive capacity, efforts should rather target the development of low cost CD4 count laboratory tests in order to enhance the management of HIV-infected patients in sub-Saharan Africa. Our results support the effectiveness of simple generic combinations for HIV treatment in sub-Saharan Africa.