Criteria for initiating highly active antiretroviral therapy and short-term immune response among HIV-1-infected patients in Côte d'Ivoire.
OBJECTIVE
The aims of this study were to determine the predictors of CD4 count below 200 cells/microL and to propose an algorithm for antiretroviral therapy initiation; and to assess the determinants of immune response to highly active antiretroviral therapy (HAART) in Côte d'Ivoire.


METHODS
A total of 615 consecutive patients attending an HIV/AIDS day hospital were enrolled in the study. We constructed a score system based on the results of a multivariate logistic regression analysis of the predictors of CD4 count <200 cells/microL with the intention of proposing an algorithm able to accurately designate patients eligible for HAART. We also identified factors associated with a short-term increase in CD4 count >50 cells/microL after HAART initiation.


RESULTS
Total lymphocyte count <1200 cells/microL (P<0.0001), lower haemoglobin levels (P<0.0001), and Centers for Disease Control and Prevention (CDC) clinical stages C (P=0.005) and B (P=0.045), as compared with stage A, were associated with CD4 count <200 cells/microL. Nonetheless, no accurate algorithm for HAART initiation was found. Three hundred and three of the 615 patients were treated. Of these 303 patients, 79.5% showed an increase of >50 cells/microL in CD4 count 6 months after HAART initiation (median increase 128 cells/microL). Adherence >or=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.


CONCLUSIONS
Our results support the effectiveness of generic drug combinations in sub-Saharan Africa. In order to enhance the management of HIV disease in sub-Saharan Africa, efforts should target the development of low-cost CD4 cell count laboratory tests.
Diabaté
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Unité de Soins Ambulatoires et de Conseils, Abidjan, Côte d'Ivoire. dsouleym@hotmail.com
Alary
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D000328:Adult; D000465:Algorithms; D000553:Ambulatory Care; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D007560:Cote d'Ivoire; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D015497:HIV-1; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D018655:Lymphocyte Count; D008297:Male; D055118:Medication Adherence; D015999:Multivariate Analysis; D018579:Patient Selection; D013223:Statistics as Topic
D019380:Anti-HIV Agents; D006454:Hemoglobins