HAART – Dependent CD4+ Lymphocyte Response Based on Pre-Therapeutic CD4 Lymphocyte Count in HIV-Infected Nigerians

Background: Increasing concerns related to cost, drug toxicity, pill burden, tolerability ability of patient to adhere to strict and complicated regimen and emergence of drug resistance has complicated the decision making process of when to start antiretroviral therapy. The present research is aimed at determining if there is any immunological advantage in initiating HAART at a pre-therapeutic CD4 count of 350cells/μl rather than at 200-350 or 200 cells/μl. Methods: One hundred HIV-infected previously antiretroviral- naive individuals grouped under 3 CD4+ lymphocyte count thresholds; 200, 200 – 350 and 350 cells/μl were randomized to take HAART of stavudine (40mg) lamivudine (150mg) and nevirapine (200mg) orally twice daily. CD4 lymphocyte count was determined serially every 8 weeks for an observation period of 48 weeks. CD4 lymphocyte count responses were compared statistically based on pre-therapeutic CD4 lymphocyte counts. Results: The overall increase in CD4 lymphocyte count irrespective of baseline CD4 count was 122 cells/μl (p 0.01). CD4 lymphocyte count response to 48 weeks HAART was significantly higher in patients initiating HAART at a pre-therapeutic CD4 count of 200 cells/μl (163 cells/μl) compared to 118 and 50 cells/μl respectively for those initiating at 200 – 350 and 350 cells/μl respectively (χ2 = 1.80, p 0.05). HIV-related morbidity of 3% was found among subjects who initiated HAART with a pre-therapeutic CD4 count of 200 cells/μl. Steven -Johnson syndrome was the commonest adverse clinical event observed occurring in 15% of subjects. Conclusion: Our study indicates that there is no long-term advantage in terms of CD4+ lymphocyte response in initiating HAART at a pre-therapeutic CD4 count of 350 cells/μl rather than at 200 – 350 cells/μl. Our present study appears to support postponing the initiation of therapy in some patients until the CD4+ count approaches 200 cells/μl particularly in sub-Saharan Africa where drug accessibility and affordability constitutes a major challenge.