title: The effect of AIDS defining conditions on immunological recovery among patients initiating antiretroviral therapy at Joint Clinical Research Centre, Uganda.
abstract: BACKGROUND
  Many HIV-infected patients only access health care once they have developed advanced symptomatic disease resulting from AIDS Defining Conditions (ADCs). We carried out a study to establish the effect of ADCs on immunological recovery among patients initiated on antiretroviral therapy (ART).
  
  
  METHODS
  A retrospective cohort of 427 HIV-1 patients who were initiated on ART between January 2002 and December 2006 was studied. Data on ADCs was retrieved from Joint Clinical Research Centre (JCRC) data base and backed up by chart reviews. We employed Kaplan-Meier survival curves to estimate median time to 50 CD4 cells/microl from the baseline value to indicate a good immunological recovery process. Cox proportional hazard models were used at multivariate analysis.
  
  
  RESULTS
  The median time to gaining 50 CD4 cells/microl from the baseline value after ART initiation was longer in the ADC (9.3 months) compared to the non-ADC group (6.9 months) (log rank test, p = 0.027). At multivariate analysis after adjusting for age, sex, baseline CD4 count, baseline HIV viral load, total lymphocyte count and adherence level, factors that shortened the median time to immunological recovery after ART initiation were belonging to the non-ADC group (HR = 1.31; 95% CI: 1.03-1.28, p = 0.028), adherence to ART of >or= 95% (HR = 2.22; 95% CI: 1.57-3.15, p = 0.001) and a total lymphocyte count >or= 1200 cells/mm3 (HR = 1.84; 95% CI: 1.22-2.78, p = 0.003). A low baseline CD4 count of <or= 200 cells/microl (HR = 0.52; 95% CI: 0.37-0.77, p = 0.001) was associated with a longer time to immunological recovery. There was no interaction between low CD4 counts and ADC group.
  
  
  CONCLUSIONS
  Patients with ADCs take longer to regain their CD4 counts due to the defect in the immune system. This may prolong their risk of morbidity and mortality.
authors.affiliation: Clinical Epidemiology Unit, Faculty of Medicine, Makerere University College of Health Sciences, P,O, BOX 7072, Kampala, Uganda. bkigozi@med.mak.ac.ug
authors.forename: Brian K
authors.initials: BK
authors.lastname: Kigozi
authors.forename: Samwel
authors.initials: S
authors.lastname: Sumba
authors.forename: Peter
authors.initials: P
authors.lastname: Mudyope
authors.forename: Betty
authors.initials: B
authors.lastname: Namuddu
authors.forename: Joan
authors.initials: J
authors.lastname: Kalyango
authors.forename: Charles
authors.initials: C
authors.lastname: Karamagi
authors.forename: Mathew
authors.initials: M
authors.lastname: Odere
authors.forename: Elly
authors.initials: E
authors.lastname: Katabira
authors.forename: Peter
authors.initials: P
authors.lastname: Mugyenyi
authors.forename: Francis
authors.initials: F
authors.lastname: Ssali