Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents

Abstract

Human immunodeficiency virus (HIV) causes acquired immune deficiency syndrome (AIDS), a pandemic causing millions of deaths each year. Management of HIV/AIDS patients rely on antiretroviral treatment (ART) to suppress viral replication and increase CD4+ T-lymphocytes levels and time to disease progression in order to enjoy health lives and reduce transmission of the virus. CD4+ count is an essential tool for initiating and monitoring of ART. CD4+ response depend on; environmental setting where treatment is being offered, individual and population characteristics including; adherence, age, gender, baseline CD4+ cell count and viral load and individuals Basal Metabolic Index (BMI), a measure of patient’s nutritional status. This study attempts to provide an updated and clear association of independent variables predicting patient’s CD4+ immune reconstitution. This was a retrospective longitudinal study of ART-naive, HIV-infected adults and adolescents initiated on standard first line ART regimen and their CD4+ response followed up for 18 months. Study population included adults and adolescents registered and initiated on standard first line ART regimen, as part of routine comprehensive care program of the Kenyan Government in conjunction with donor partners; USAID, ICAP and EGPAF at Masaba-North SubCounty PSC/CCC. Data obtained within the study period of four years; 2012 to 2015 was analyzed statistical using multilevel mixed effect linear models in STATA for BMI categories of CD4+ level intercept values and other variables coefficients and compared to their reference groups to obtain P values. Repeated measures of ANOVA were used to determine differences in CD4+ mean response between the four intervals of measurement. Results from the study indicate that BMI is an independent predictor of CD4+ lymphocytes immune reconstitution for patients on ART. Age, Gender, and Number of ART interruptions were statistically significant when other variables were accounted for in the model over the 18 months of follow up. BMI and WHO clinical stage were less statistically significant