Research
Immune restoration disease and changes in CD4+ T-cell count in HIV- infected patients during highly active antiretroviral therapy at Zewditu memorial hospital, Addis Ababa, Ethiopia
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* Corresponding author: Kahsay Huruy kasaye88@yahoo.com
1 Department of Medical Laboratory Technology, College of Medicine and Health Sciences, University of Gondar, Ethiopia
2 Institute of Virology, Faculty of Medicine, University of Leipzig, Germany
3 Department of Microbiology and Parasitology, College of Medicine and Health Sciences, University of Gondar, Ethiopia
4 Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado, Denver, USA
5 Faculty of Social Sciences and Humanities, University of Gondar, Gondar, Ethiopia
6 Institute of Psychology II, Clinical and Health Psychology, University of Leipzig, Germany
AIDS Research and Therapy 2010, 7:46 doi:10.1186/1742-6405-7-46
Published: 21 December 2010Abstract
Background
Highly active antiretroviral therapy (HAART) improves the immune function and decreases morbidity, mortality and opportunistic infections (OIs) in HIV-infected patients. However, since the use of HAART, immune restoration disease (IRD) has been described in association with many OIs. Our objective was to determine the proportion of IRD, changes in CD4+ T-cell count and possible risk factors of IRD in HIV-infected patients.
Methods
A retrospective study of all HIV- infected patients starting HAART between September 1, 2005 and August 31, 2006 at Zewditu memorial hospital HIV clinic, Addis Ababa, Ethiopia was conducted. All laboratory and clinical data were extracted from computerized clinic records and patient charts.
Results
A total of 1166 HIV- infected patients with mean ± SD age of 36 ± 9.3 years were on HAART. IRD was identified in 170 (14.6%) patients. OIs diagnosed in the IRD patients were tuberculosis (66.5%, 113/170), toxoplasmosis (12.9%, 22/170), herpes zoster rash (12.9%, 22/170), Pneumocystis jirovecii pneumonia (4.1%, 7/170), and cryptococcosis (3.5%, 6/170). Of the 170 patients with IRD, 124 (72.9%) patients developed IRD within the first 3 months of HAART initiation. Low baseline CD4+ T-cell count (odds ratio [OR], 3.16, 95% confidence interval [CI], 2.19-4.58) and baseline extra pulmonary tuberculosis (OR, 7.7, 95% CI, 3.36-17.65) were associated with development of IRD. Twenty nine (17.1%) of the IRD patients needed to use systemic anti-inflammatory treatment where as 19(11.2%) patients required hospitalization associated to the IRD occurrence. There was a total of 8 (4.7%) deaths attributable to IRD.
Conclusions
The proportion and risk factors of IRD and the pattern of OIs mirrored reports from other countries. Close monitoring of patients during the first three months of HAART initiation is important to minimize clinical deterioration related to IRD.