Determinants of change in CD4 count and relationship with survival among children with HIV in Ethiopia

ABSTRACT

We identify the determinants of the change in CD4 cell count and survival time of children living with HIV taking antiretroviral therapy. In a retrospective study, a cohort of 201 children living with HIV/AIDS aged less than 15 years were followed from October 2013 to March 2017. Separate linear effect models were done for the longitudinal outcome of CD4 cell count. The Cox PH model was conducted for the time-to-event outcome. Joint modeling was performed both for the longitudinal and survival outcomes, results were compared with the separate analysis. However, with the specific interest in identifying the determinants and characterizing the relationship between longitudinal CD4 cell count and time-to-event outcomes, the study focused on joint modeling. The finding from the joint model indicated that the estimated association parameter was −0.10, this shows lower values of CD4 cells associated with higher death. Seemingly; observation time, age, WHO clinical stages, history of Tuberculosis (assuming that Tuberculosis is active), and functional status were determinants for the mean change in the square root of CD4 cell count. Furthermore, WHO clinical stages, functional status, history of TB, and Body Mass Index have a significant negative impact on the survival probabilities of children living with HIV.

KEYWORDS:

• HIV/AIDS
• children
• joint model
• CD4 cell count
• time to death

Acknowledgements

We thank Arba Minch University for providing necessary facilities and we extended our gratitude to staff in Adama Hospital who were working in the ART unit, for their kind cooperation in providing all the data. The first author designed the study, analyzed the data, drafted the manuscript, and critically reviewed the article. All authors read and approved the final manuscript. The study was carried out after getting permission from the Statistics Department, Arba Minch University. In this regard, the official letter of co-operation referenced with stat/319/2011 was written to concerned bodies.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The dataset supporting the conclusions of this article is available by contacting the authors.