Time to Immunologic Recovery and Its Determinant Factors Among Adult HIV Patients Who Initiated Antiretroviral Treatment at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

Abstract

Objective

To determine the time to immunologic recovery and its determinant factors among adult HIV patients who initiated antiretroviral treatment at Hiwot Fana Specialized University Hospital from February, 2018 to January, 2020.

Methods

A facility-based retrospective cohort study was conducted among 301 adult HIV patients who initiated antiretroviral treatment from February, 2018 to January, 2020. Five trained nurses collected the data using data abstraction checklists. The collected data were entered into the computer using EpiData version 3.1 and then exported to Statistical Package for Social Sciences (SPSS) version 25. The median survival time to immunologic recovery was described using Kaplan–Meier (KM) estimator. Cox proportional hazards regression model was used to identify the potential determinant factors of the time to immunologic recovery. An adjusted hazard ratio (AHR) with its 95% confidence interval (CI) and p-values <0.05 were used to determine the strength and significance of associations between variables.

Results

In this study, the overall median time required to reach normal CD4 count was 11 months [95% CI = (9.50, 12.51)]. Baseline functional status, ambulatory [AHR=1.383, 95% CI (1.05, 1.83)], bedridden [AHR=1.712 (1.11, 2.64)], first-line treatment classes (TDF/3TC/DTG) [AHR= 1.63, 95% CI (1.21, 2.18)], and baseline CD4 count > 350 cells/mm3 [AHR=1.65, 95% CI (1.11, 2.45)] were significantly associated with the time to immunologic recovery.

Conclusion

The median time to immunologic recovery was relatively shorter. Baseline functional status (ambulatory and bedridden), baseline CD4 count, and first-line treatment class were significant predictors of time to immunologic recovery. HIV patients with working functional status should be given the necessary attention. Utilization of dolutegravir-based regimens should be encouraged to attain a normal CD4 count earlier.

Keywords:

• time to immunologic recovery
• CD4 count
• Harer
• Ethiopia

Abbreviations

AIDS, acquired immunodeficiency syndrome; AHR, adjusted hazard ratio; ART, antiretroviral therapy; CD4, cluster of differentiation 4; CI, confidence interval; DTG, Dolutegravir; FDC, fixed dose combination; HFSUH, Hiwot Fana Specialized University Hospital; PLHIV, People Living with Human Immunodeficiency Virus; WHO, World Health Organization.

Acknowledgment

We would like to thank Haramaya University, College of Health and Medical sciences and School of Pharmacy for the assistance to conduct this study.

Author Contributions

All authors made a significant contribution throughout the work, i.e, in the conception of the study, study design, execution, acquisition of the data, analysis and interpretation of the result, in drafting the manuscript, revising the article, gave final approval of the version to be published, have agreed on the journal to which the article has been submitted and agreed to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

There was no funding source for this study.