The effects of highly active antiretroviral therapy (HAART) of stavudine, lamivudine and nevirapine on the CD4 lymphocyte count of HIV-infected Africans: the Nigerian experience

Abstract

Objectives: The objective of this study was to investigate the short-term effect of highly active antiretroviral therapy on the CD4 lymphocyte count of HIV-infected Nigerians.

Design: A case control study of 70 HIV-infected subjects placed on highly active antiretroviral therapy. Thirty HIV-infected yet to start therapy due to unaffordability were observed as controls.

Setting: This study was carried out at the Hematology Department of the University of Port Harcourt Teaching Hospital a 500 bed tertiary hospital and one of the designated antiretroviral therapy pilot centers.

Methods: CD4 lymphocyte count was determined at baseline for subjects and controls. Subjects were placed on HAART for 12 weeks while controls that were yet to start therapy were monitored as controls. CD4 lymphocyte count was repeated after 12 weeks and the differences compared statistically.

Results: We observed that subjects and control patients did not differ significantly in their CD4 lymphocyte count at baseline (p>0.05), but after 12 weeks HAART in subjects and untreated control there was a mean increase in CD4 count of (39 cells/microL) in subjects, while untreated controls showed a mean decline of (12 cells/microL) p< 0.05. There was a statistically significant variation in the therapy dependent increases in CD4 count of HAART treated subjects based on pre-therapeutic baseline CD4 count (divide2 = 180.39, p<0.05). The HAART dependent increase in CD4 counts was higher in younger subjects 19-28 years (31 cells/microL) compared to older subjects 49-58 years (21 cells/microL) (p = 0.01). Similarly CD4 response was found higher in females compared to males (p = 0.01).

Conclusion: This study indicates the importance of accessing the CD4 lymphocyte count of HIV infected patients before the initiation of HAART, its use as a prognostic maker in predicting the initial response to HAART and in determining the optimal time to initiate therapy.