Immunologic Response of HIV-Infected Children to Different Regimens of Antiretroviral Therapy: A Retrospective Observational Study

الملخص EN

Both abacavir- (ABC-) based and zidovudine- (AZT-) based regimens are widely utilized for managing HIV infection in children.

Unfortunately, there is a lack of data regarding their immunological response and associated risk factors in Ethiopia.

Methods.

A retrospective hospital-based cohort study was conducted on HIV-infected children in Jimma Medical Center (JMC).

A total of 179 records were reviewed by including data from November 2015 to April 2017.

Data were collected on sociodemographic, clinical characteristics of patients and drug-related variables.

Data analysis was done using STATA 13.1.

Mixed-effect linear regression was performed to assess the difference in CD4+ changes between groups adjusting for baseline characteristics.

The change in predicted CD4 count attributed to each regimen was also assessed by marginal analysis.

P<0.05 for slope of the random-effect linear regression was used as an indicator for the presence of association.

Result.

Of 179 patients, 98 (54.7%) were females.

The mean (±SD) duration of follow-up was 939.8 ± 478.3 and 984.92 ± 453.1 days for ABC and AZT groups, respectively.

AZT group had a significant CD4+ count gain per visit compared with their ABC counterparts ((β = 20.51, 95% CI [6.37–34.65]), P=0.004) over time.

The regimen AZT + 3TC + LPV/r tended to have an excellent predicted CD4+ lymphocyte count change relative to all other regimens, while ABC + 3TC + LPV/r had the least immunologic recovery (margins 338.0 cells/mm3 versus 249.13 cells/mm3 (P<0.001)).

Baseline CD4+ lymphocyte count, ART group, WHO clinical stages, and viral load were independent predictors for CD4+ change overtime.

Conclusion.

AZT-based regimens seem to have better immunological response compared to ABC-based regimens.

Immunologic response was described worse in patients with a viral load of >1000copies/ml, low baseline CD4+ count, advanced WHO clinical stages, and ABC-containing regimens.

Further study is needed to clarify these aspects.