American Journal of Microbiological Research
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American Journal of Microbiological Research. 2016, 4(1), 41-46
DOI: 10.12691/ajmr-4-1-5
Open AccessArticle

A Single Center Experience: Short Term CD4 Count Monitoring and Rate of Opportunistic Infections in Human Immunodeficiency Virus (HIV) Infected Patients

Hythum Salah H. Mohamed1, , Adel Alothman2, Henry Baffoe-Bonnie2 and Hisham Alageeb3

1Department of Medicine, Division of Infectious Diseases, National Guard Health Affairs, Riyadh, Saudi Arabia

2Department of Medicine, Divsion of Infectious Diseases, King Abdulaziz Medical City, Riyadh, Saudi Arabia

3Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia

Pub. Date: February 25, 2016

Cite this paper:
Hythum Salah H. Mohamed, Adel Alothman, Henry Baffoe-Bonnie and Hisham Alageeb. A Single Center Experience: Short Term CD4 Count Monitoring and Rate of Opportunistic Infections in Human Immunodeficiency Virus (HIV) Infected Patients. American Journal of Microbiological Research. 2016; 4(1):41-46. doi: 10.12691/ajmr-4-1-5

Abstract

Background/Objectives: CD4 cell count is a key measure of Human immunodeficiency virus (HIV) disease progression and for the risk of developing a life-threatening opportunistic infections (OIs). We designed this study to assess and monitor CD4 count at baseline and response to antiretroviral therapy (ART) at 6 and 12 months and to know the prevalence of OIs among all adult with HIV-infection in a tertiary care hospital in Saudi Arabia (SA). Material/methods: Retrospective study was conducted with a total of 61 HIV seropositive patients attended at King Abdulaziz Medical City-Riyadh from January 2005 to November 2015, data was collected and recorded form patients’ charts, electronic health record system and HIV database for age, gender, nationality, CD4 count at baseline for all patients and at 6 months and 12 months for patients receiving ART and OIs. Flow cytometry was used for absolute CD4 count measurement. Identification of all causative microorganisms of OIs was performed by the standard microbiologic methods with clinical correlation. Results: Majority, 46/61(75.4%) of study participants were male patients. The mean age of participants was 44.39 with std of +/- 13.375 years. Mean baseline CD4 count for all study participants was 285.28 with std of +/- 306.333 cells/μL. Distribution of baseline CD4 count for all patients was, DC4 count less than 200 cells/μL were 34/61(55.7%), CD4 count from 200-500 cells/μL were 13/61(21.3%) and CD4 count more than 500 cells/μL were 14/61(23.0%). A total of 30/61 patients (49.2%) were not receiving ART and 31/61 patients (51.8%) were receiving ART. A total of 22/61 (36.1%) OIs were observed from the study participants. Commonly observed OIs were Cytomegalovirus (CMV) 14/61 (23.0%) (Positive IgG and IgM antibodies, pp65 antigen and PCR without clinical correlation), Tuberculosis 4/61(6.6%), pneumocystis pneumonia 2/61(3.3%) Toxoplasmosis 2/61(3.3%), Syphilis 2/61(3.3), varicella zoster virus (VZV) 1/61(1.6%), herpes simplex virus (HSV) 1/61 (1.6%). Conclusions: Half of HIV-infected patients 55.7% in this study were severely immunocompromised at the time of HIV diagnosis. Half of patients receiving ART were nonadherence to medications and 21% of patients had a poor immunologic response after one year of adherence to ART. One-third of our HIV-positive patients were infected with one or more OIs.

Keywords:
CD4 count HIV Opportunistic Infections Saudi

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Al-mozaini M, Mansour MK, Al-hokail A. HIV-Care Outcome in Saudi Arabia; a Longitudinal Cohort. J AIDS Clin Res 2014; 5(11): 370.
 
[2]  Collazos J, Asensi V, Carton JA (2007) Sex differences in the clinical, immunological and virological parameters of HIV-infected patients treated with HAART. AIDS 21: 835-843.
 
[3]  WHO Report: impact of antiretroviral on the incidence opportunistic infections in resource-limited setting: A systemic review and meta -2013.
 
[4]  Gilks CF, Crowley S, Ekpini R, et al. The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings. Lancet. 2006; 3689534: 505-510.
 
[5]  Ford D, Robins JM, Petersen ML. The Impact of Different CD4 Cell-Count Monitoring and Switching Strategies on Mortality in HIV-Infected African Adults on Antiretroviral Therapy: An Application of Dynamic Marginal Structural Models. Am J Epidemiol 2015; 182(7): 633-643.
 
[6]  Tang H, Mao Y, Shi CS. Baseline CD4 Cell Counts of Newly Diagnosed HIV Cases in China: 2006-2012. PLOS Journals 2014; 9(6): e96098.
 
[7]  Kilaru KR, Kumar A, Sippy N. CD4 cell counts in adults with newly diagnosed HIV infection in Barbados, CSIELO Public Health 2004; 16(5):302-7.
 
[8]  Kim SG, Gerver SM, Fidler S. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS 2014; 28(13):1945-1956.
 
[9]  Van Der Linden D, Lapointe N, Ransy DG, Motorina A, Soudeyns H, Lamarre V. Portrait of antiretroviral drug resistance in HIV-1-infected adolescents prior to their transfer to adult care: an exploratory study. Canad J Infect Dis Med Microbiol 2011; 22: 13B.
 
[10]  Eisen S, Barkley L, Schepers C, Gurney K, Clapson M, Shingadia D, et al. Impact of transition to adult services on clinic attendance and virological control in HIV-infected adolescents. HIV Med2009; 10:45.
 
[11]  Ellis J, Norrish G, Elgalib A. HIV positive adolescents: characteristics and treatment challenges. HIV Med 2012; 13:38.
 
[12]  Memish ZA, Al-tawfiq JA, Filemban SM. Antiretroviral therapy, CD4, viral load, and disease stage in HIV patients in Saudi Arabia: a 2001-2013 cross-sectional study, J Infect Dev Ctries 2015; 9(7):765-769.
 
[13]  Alrajhi AA, Halim MA, Al-Abdely HM (2006) Presentation and reasons for HIV-1 testing in Saudi Arabia. Int J STD AIDS 17: 806-809.
 
[14]  Mazroa MA, Kabbash IA, Felemban SM, Stephens GM, AlHakeem RF, Zumla AI, Memish ZA (2012) HIV case notification rates in the Kingdom of Saudi Arabia over the past decade (2000-2009). PloS One 7: e45919.
 
[15]  Al-Mazrou YY, Abouzeid MS, Al-Jeffri MH (2005) Impact of health education on knowledge and attitudes of Saudi paramedical students toward HIV/AIDS. Saudi Med J 26: 1788-1795.
 
[16]  Rubaihayo J, Tumwesigye NM, Konde-lule J. Trends in prevalence of selected opportunistic infections associated with HIV/AIDS in Uganda. BMC Infectious Diseases 2015; 15(187):1471-2334.
 
[17]  Staine JG. AIDS up date 2007: An overview of acquired immune deficiency syndrome. New York McGraw-Hill co., Inc; 2008.
 
[18]  Bruno R, Sacchi P, Filice G: Overview on the incidence and the characteristics of HIV-related opportunistic infections and neoplasms of the heart: impact of highly active antiretroviral therapy.
 
[19]  Warszawski J, de Wit S, Zangerle R, Fabre-Colin C, et al.: The Incidence of AIDS-Defining Illnesses at a Current CD4 Count > =200 Cells/μL in the Post-Combination Antiretroviral Therapy Era.
 
[20]  HIV-related opportunistic infections. MBJ best practice [homepage on the Internet]. 2013 [cited 2015 Dec 1]. Available from: http://bestpractice.bmj.com/best-practice/monograph/899/basics/epidemiology.html.
 
[21]  Saeed NK, Farid E, Jamsheer AE. Prevalence of opportunistic infections in HIV-positive patients in Bahrain: a four-year review (2009-2013), J Infect Dev Ctries 2015; 9(1):060-069.
 
[22]  Kingston ME, Harder EJ, Al-Jaberi MM, Bailey TM, Roberts GT, et al. Acquired immune deficiency syndrome in the Middle East from imported blood. Transfusion. 1985; 25:317-318.
 
[23]  Closing the gap in HIV prevention and treatment. [homepage on the Internet]. 2014 [cited 2015 Dec 1]. Available from, Saudi Ministry of Health Web site: /http://www.moh.gov.sa.
 
[24]  Delmas MC, Jadand C, De Vincenzi I, Deveau C, Persoz A, Sobel A, et al. Gender difference in CD4+ cell counts persist after HIV-1 infection. SEROCO Study Group. AIDS 1997; 11:1071-1073.
 
[25]  Finkel DG, John G, Holland B, Slim J, Smith SM. Women have a greater immunological response to effective virological HIV-1 therapy. AIDS 2003; 17:2009-2011.
 
[26]  Mocroft A, Gill MJ, Davidson W, Phillips AN. Are there gender differences in starting protease inhibitors, HAART, and disease progression despite equal access to care? J Acquir Immune Defic Syndr 2000; 24:475-482.
 
[27]  Prins M, Robertson JR, Brettle RP, Aguado IH, Broers B, Boufassa F, et al. Do gender differences in CD4 cell counts matter? AIDS 1999; 13:2361-2364.
 
[28]  WHO guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV- September 2015.