Assessment of immunological response during HAART; its correlation with viral load and associated factors of treatment failure among HIV/AIDS patients attending University of Gondar Referral Hospital Northwest Ethiopia

Abstract

Abstract Background: The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or harming their function. Viral load (VL) and CD4+ T cell count are vital for initial evaluation of HIV-infected patients and to monitor the virologic and immunologic efficiency of ART. However, in Ethiopia VL determination was started recently and there is no study that shows its correlation with CD4+. Objective: The overall aim of this study was to assess immunological response during HAART; its correlation with Viral Load and associated factors of treatment failure among HIV/AIDS patients attending University of Gondar Referral Hospital, Northwest Ethiopia. Methods: Hospital based cross-sectional study and retrospective record review was conducted in 423 HIV/AIDS patients on ART from February to April 2017.Demographic and clinical data collected using structured questionnaire and from their medical records. Ten milliliter of venous blood was collected for CD4+ T cell count and HIV-1 viral load testing. Data was analyzed using SPSS version 20 and P value less than 0.05 was considered as statistically significant. Results: A total of 423 HIV patients on ART with a minimum of 6 months and up to 12 years of treatment were enrolled. The mean CD4 + T cell count gradually increased until year 8 but declined after this year. Immunological status before and after HAART had positive correlation[r= 0.285 p= 0.000]. Whereas, immunological and virological status at data collection time had week negative correlation (r= -0.243 (𝑝 = 0.000). The prevalence of treatment, immunological and virological failure was 20.3%, 13.2% and 14.7%, respectively. Patients who had no formal education, primary level education and duration on ART < 6 years were a significant risk factor. However, initial adult regimen D4T+3TC+ EFV, AZT +3TC+NVP, AZT+3TC+EFV and TDF+3TC+EFV were significantly protective for treatment failure. Conclusion: Monitoring of ART effectiveness should be done for each HIV patient using virological and immunological tests. It is preferable to initiate ART using any one of the following ART regimens: AZT +3TC+NVP, AZT+3TC+EFV and TDF+3TC+EFV to prevent treatment failure. Further research in a wider community and multiple ART centers is needed.