The effects of antiretroviral drugs on cd4 cells in HIV positive patients attending Nakuru general hospital, Kenya
Mugwe, J. N.
Gicheru, M. M.
MetadataShow full item record
The Human Immunodeficiency Virus (HIV) is the etiologic agent for Acquired Immunodeficiency Syndrome (AIDS). AIDS represents a global health crisis that threatens to overwhelm even the best health care delivery systems. The virus predominantly infects CD4 cells, which play an important role in the immune system. Infection with HIV results in a progressive destruction of the CD4 lymphocytes, and subsequent development of HIV related opportunistic infections. The destruction of the T-cells is due mainly to active viral replication. A specific immune response to HIV occurs in HIV infected patients during primary infection and the strength of the primary immune response may be predictive of subsequent viral load in the body. CD4 T cell count and is part of the laboratory data, which give guidelines on Commencement, and subsequent monitoring of chemotherapy. The collapse of the immune system in AIDS reflects the central role of CD4 T cells in both humeral and cell mediated responses and in the regulation of both responses. The primary goal of antiretroviral therapy is optimal and durable suppression of viral load, preservation and / or restoration of immunologic function, improvement of life and reduction of HIV related morbidity and mortality. An important aspect of antiretroviral treatment is accurate determination of when to commence and stop chemotherapy. CD4 T cell counts are essential for managing therapy and it is evident that these two important parameters vary from region to region. The objective of the study was to monitor and assess the immunological responses of HIV –infected individuals with administration of Antiretroviral drugs (ARVs) and more importantly the effect of chemotherapy was assessed. The study was conducted between January and June, 2006, on people who were voluntarily attending Voluntary Counseling and Testing center in Nakuru General Hospital after getting consent from the hospital’s administration. A cross sectional study design that involved selecting subjects and obtaining information was used to sample the study group and a total of 80 patients, 12 males and 68 females participated in the study. Screening for HIV was performed by parallel testing using Determine and UniGold HIV1/2 test kits. On testing HIV positive, the patients were referred to the Centre for Comprehensive Care, Nakuru, where CD4 counts were determined using BD FACS count prior to commencement of antiretroviral regimens. Immunologic responses to therapy were determined by measuring CD4 counts at two weeks interval on commencement of ARVs and monthly for three subsequent months thereafter in all eighty patients, the highest CD4 count detected at the baseline was 220 cells/mm3 of blood and the lowest was 8 cells/mm3 of blood. The patients were categorized into three groups: those with less than 100 cells/mm3 of blood, those with between 100-200 T cells/mm3of blood and those with more than 200 T cells/mm3 of blood. The overall mean CD4T cell counts before commencement of chemotherapy was 126 and after fourteen weeks of chemotherapy the mean CD4 count increased to 278. Patients had varied responses to chemotherapy. Increases in CD4 counts was observed as early as two weeks after initiating chemotherapy, an indication that patients were responding to ARVs and achieving an improvement in immunologic functions. Response to chemotherapy between the categories over the entire fourteen weeks was compared by regression analyses. Patients with 100-200 cells/mm3 were found to have significantly better response (P<0.01; t = 19.7332) than the patients with less than 100 cells/mm3 and patients with more than 200cells/mm3 of blood. Antiretroviral therapy was found to have effects onCD4 counts hence CD4 counts are predictive of the benefits of chemotherapy. Data generated will be useful in improvement of HIV management strategies. Key words:Human Immunodeficiency Virus; CD4 T cell counts; Antiretroviral therapy; Immune responses