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Varied Immunological Response to Test and Treat with Antiretroviral Therapy: A Longitudinal Study with Mixed Model
Manvendra Singh Rathore1, Mohamed Anas Mohamed Faruk Patni2, Rajesh Gopal3
1Department of Community Medicine, Government Medical College, Surat, Gujarat, India.
Background:
The Test and Treat Policy (2017) of antiretroviral therapy (ART) was launched in India to achieve treatment goals more effectively than previous strategies. The study aimed to establish association of sociodemographic and clinical characteristics with immunological response to ART among patients living with HIV/AIDS (PLHIV) initiated on ART under the Test and Treat policy.
Material And Methods:
It was a longitudinal study conducted in a tertiary care hospital of South Gujarat, India, where data were collected from 318 PLHIV newly initiated on ART in 2018-19 regarding baseline and subsequent clinical (CD4 count, adherence, opportunistic infections, side effects) profiles. Association of these variables with CD4 count changes overtime was examined using repeated measures correlation and mixed models analysis.
Results:
Participants (63.2%) had a baseline CD4 count of less than 350 cells/cu.mm. Repeated measures correlation with adherence and rise in CD4 was significant in participants with baseline CD4 of 301-500 cells/cu.mm (ρ = 0.280, P = 0.005) and those with above 500 cells/cu.mm (ρ =0.224, P = 0.03). The mixed model consisting of time, category of baseline CD4, and gender was the best fitting model. CD4 increased by an average of 48 cells/mm3 (95% CI: 27-70 cell/cu.mm, P = 0.00) between 6 and 18 months of ART. Baseline CD4 was a predictor in determining rise in CD4.
Conclusion:
Lower baseline CD4 was not associated with significant rise despite early ART initiation. Significantly higher CD4 rise was seen in females. The majority of PLHIV were symptomatic with low baseline CD4. This opens the avenue for strengthening HIV/STI testing services for early detection and bidirectional screening.
