Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4<sup>+</sup> T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents

Mosioma Philip Nyaribo; Otundo Denis Orare; Wambura Francis Muchiri; Chimbevo Mwagandi Lenny; Mutkuka John Kyalo; Wang’ombe Anne

doi:doi:10.11648/j.ijhpebs.20170303.12

Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4⁺ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents

Mosioma Philip Nyaribo, Otundo Denis Orare, Wambura Francis Muchiri, Chimbevo Mwagandi Lenny, Mutkuka John Kyalo, Wang’ombe Anne

Published in International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 3, Issue 3)

Received: 23 June 2017 Accepted: 1 September 2017 Published: 26 September 2017

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Abstract

Human immunodeficiency virus (HIV) causes acquired immune deficiency syndrome (AIDS), a pandemic causing millions of deaths each year. Management of HIV/AIDS patients rely on antiretroviral treatment (ART) to suppress viral replication and increase CD4+ T-lymphocytes levels and time to disease progression in order to enjoy health lives and reduce transmission of the virus. CD4+ count is an essential tool for initiating and monitoring of ART. CD4+ response depend on; environmental setting where treatment is being offered, individual and population characteristics including; adherence, age, gender, baseline CD4+ cell count and viral load and individuals Basal Metabolic Index (BMI), a measure of patient’s nutritional status. This study attempts to provide an updated and clear association of independent variables predicting patient’s CD4+ immune reconstitution. This was a retrospective longitudinal study of ART-naive, HIV-infected adults and adolescents initiated on standard first line ART regimen and their CD4+ response followed up for 18 months. Study population included adults and adolescents registered and initiated on standard first line ART regimen, as part of routine comprehensive care program of the Kenyan Government in conjunction with donor partners; USAID, ICAP and EGPAF at Masaba-North Sub-County PSC/CCC. Data obtained within the study period of four years; 2012 to 2015 was analyzed statistical using multilevel mixed effect linear models in STATA for BMI categories of CD4+ level intercept values and other variables coefficients and compared to their reference groups to obtain P values. Repeated measures of ANOVA were used to determine differences in CD4+ mean response between the four intervals of measurement. Results from the study indicate that BMI is an independent predictor of CD4+ lymphocytes immune reconstitution for patients on ART. Age, Gender, and Number of ART interruptions were statistically significant when other variables were accounted for in the model over the 18 months of follow up. BMI and WHO clinical stage were less statistically significant.

Published in	International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 3, Issue 3)
DOI	10.11648/j.ijhpebs.20170303.12
Page(s)	28-35
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Body Mass Index, Antiretroviral Treatment, ANOVA

References

[1]	WHO. (2014). GLOBAL UPDATE ON HEALTH SECTOR RESPONSE TO HIV. GENEVA: WHO.
[2]	WHO HIV/AIDS statistics retrieved on 12^th July, 2016. http://www.who.int/gho/hiv/en/
[3]	Alana T. B, Mhairi M, Ian S, et al. The interplay between CD4 cell count, viral load suppression and duration of ART on mortality in a resource-limited setting. Tropical Medicine International Health. 2013 May; 18(5): 619–631.
[4]	Gupta A, Nadkarni G, Yang W-T, et al. Early Mortality in Adults Initiating Antiretroviral Therapy (ART) in Low- and Middle-Income Countries (LMIC): A Systematic Review and Meta-Analysis.2011 PLoS ONE 6(12): e28691. doi:10.1371/journal.pone.0028691
[5]	Ayalu A. R, Sibhatu B, Amare D, et al. Predictors of Change in CD4 Lymphocyte Count and Weight among HIV Infected Patients on Anti-Retroviral Treatment in Ethiopia: A Retrospective Longitudinal Study. PLoS ONE 8(4): e58595. doi:10.1371/journal.pone.0058595
[6]	James H. McMahon, Christine A. Wanke, Julian H. E, et al. Repeated assessments of food security predict CD4 change in the setting of antiretroviral therapy. Journal of Acquired Immune Deficiency Syndrome. 2011 September 1; 58(1): 60–63.
[7]	HIV and AIDS estimates (2014) Kenya retrieved on 12^th July, 2015. http://www.unaids.org/.../kenya
[8]	Kiefer E, Hoover DR, Shi Q, Dusingize J-C, et al. (2011). Association of pre-treatment nutritional status with change in CD4 count after Antiretroviral therapy at 6, 12, and 24 months in Rwandan women. PLoS ONE 6(12): e29625. doi:10.1371/journal.pone.0029625.
[9]	Palermo TM, Long AC, Lewandowski AS, Drotar D, Quittner AL, Walker LS. (2008). Evidence-based assessment of health-related quality of life and functional impairment in pediatric psychology. J Pediatr Psychol. 2008 Oct;33(9):983-96; discussion 997-8. doi: 10.1093/jpepsy/jsn038.
[10]	Crum-Cianflone, Nancy F, Mollie R, et al. Impact of Weight on Immune Cell Counts among HIV-Infected Persons. CLINICAL AND VACCINE IMMUNOLOGY, June 2011, p. 940–946 Vol. 18, No. 6.
[11]	Maman D, Pujades-Rodriguez M, Subtil F, et al. (2012) Gender Differences in Immune Reconstitution: A Multicentric Cohort Analysis in Sub-Saharan Africa. PLoS ONE 7(2): e31078. doi:10.1371/journal.pone.0031078
[12]	Aaron J, Blashill, Ph. D. Kenneth H, et al Body mass index, immune status and virological control in HIV-infected men who have sex with men. Jornal of International Association Providing AIDS Care. 2013; 12(5): 319–324.

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APA Style

Mosioma Philip Nyaribo, Otundo Denis Orare, Wambura Francis Muchiri, Chimbevo Mwagandi Lenny, Mutkuka John Kyalo, et al. (2017). Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 3(3), 28-35. https://doi.org/10.11648/j.ijhpebs.20170303.12

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ACS Style

Mosioma Philip Nyaribo; Otundo Denis Orare; Wambura Francis Muchiri; Chimbevo Mwagandi Lenny; Mutkuka John Kyalo, et al. Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2017, 3(3), 28-35. doi: 10.11648/j.ijhpebs.20170303.12

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AMA Style

Mosioma Philip Nyaribo, Otundo Denis Orare, Wambura Francis Muchiri, Chimbevo Mwagandi Lenny, Mutkuka John Kyalo, et al. Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents. Int J HIV/AIDS Prev Educ Behav Sci. 2017;3(3):28-35. doi: 10.11648/j.ijhpebs.20170303.12

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@article{10.11648/j.ijhpebs.20170303.12,
  author = {Mosioma Philip Nyaribo and Otundo Denis Orare and Wambura Francis Muchiri and Chimbevo Mwagandi Lenny and Mutkuka John Kyalo and Wang’ombe Anne},
  title = {Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {3},
  number = {3},
  pages = {28-35},
  doi = {10.11648/j.ijhpebs.20170303.12},
  url = {https://doi.org/10.11648/j.ijhpebs.20170303.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20170303.12},
  abstract = {Human immunodeficiency virus (HIV) causes acquired immune deficiency syndrome (AIDS), a pandemic causing millions of deaths each year. Management of HIV/AIDS patients rely on antiretroviral treatment (ART) to suppress viral replication and increase CD4+ T-lymphocytes levels and time to disease progression in order to enjoy health lives and reduce transmission of the virus. CD4+ count is an essential tool for initiating and monitoring of ART. CD4+ response depend on; environmental setting where treatment is being offered, individual and population characteristics including; adherence, age, gender, baseline CD4+ cell count and viral load and individuals Basal Metabolic Index (BMI), a measure of patient’s nutritional status. This study attempts to provide an updated and clear association of independent variables predicting patient’s CD4+ immune reconstitution. This was a retrospective longitudinal study of ART-naive, HIV-infected adults and adolescents initiated on standard first line ART regimen and their CD4+ response followed up for 18 months. Study population included adults and adolescents registered and initiated on standard first line ART regimen, as part of routine comprehensive care program of the Kenyan Government in conjunction with donor partners; USAID, ICAP and EGPAF at Masaba-North Sub-County PSC/CCC. Data obtained within the study period of four years; 2012 to 2015 was analyzed statistical using multilevel mixed effect linear models in STATA for BMI categories of CD4+ level intercept values and other variables coefficients and compared to their reference groups to obtain P values. Repeated measures of ANOVA were used to determine differences in CD4+ mean response between the four intervals of measurement. Results from the study indicate that BMI is an independent predictor of CD4+ lymphocytes immune reconstitution for patients on ART. Age, Gender, and Number of ART interruptions were statistically significant when other variables were accounted for in the model over the 18 months of follow up. BMI and WHO clinical stage were less statistically significant.},
 year = {2017}
}

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TY  - JOUR
T1  - Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents
AU  - Mosioma Philip Nyaribo
AU  - Otundo Denis Orare
AU  - Wambura Francis Muchiri
AU  - Chimbevo Mwagandi Lenny
AU  - Mutkuka John Kyalo
AU  - Wang’ombe Anne
Y1  - 2017/09/26
PY  - 2017
N1  - https://doi.org/10.11648/j.ijhpebs.20170303.12
DO  - 10.11648/j.ijhpebs.20170303.12
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 28
EP  - 35
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20170303.12
AB  - Human immunodeficiency virus (HIV) causes acquired immune deficiency syndrome (AIDS), a pandemic causing millions of deaths each year. Management of HIV/AIDS patients rely on antiretroviral treatment (ART) to suppress viral replication and increase CD4+ T-lymphocytes levels and time to disease progression in order to enjoy health lives and reduce transmission of the virus. CD4+ count is an essential tool for initiating and monitoring of ART. CD4+ response depend on; environmental setting where treatment is being offered, individual and population characteristics including; adherence, age, gender, baseline CD4+ cell count and viral load and individuals Basal Metabolic Index (BMI), a measure of patient’s nutritional status. This study attempts to provide an updated and clear association of independent variables predicting patient’s CD4+ immune reconstitution. This was a retrospective longitudinal study of ART-naive, HIV-infected adults and adolescents initiated on standard first line ART regimen and their CD4+ response followed up for 18 months. Study population included adults and adolescents registered and initiated on standard first line ART regimen, as part of routine comprehensive care program of the Kenyan Government in conjunction with donor partners; USAID, ICAP and EGPAF at Masaba-North Sub-County PSC/CCC. Data obtained within the study period of four years; 2012 to 2015 was analyzed statistical using multilevel mixed effect linear models in STATA for BMI categories of CD4+ level intercept values and other variables coefficients and compared to their reference groups to obtain P values. Repeated measures of ANOVA were used to determine differences in CD4+ mean response between the four intervals of measurement. Results from the study indicate that BMI is an independent predictor of CD4+ lymphocytes immune reconstitution for patients on ART. Age, Gender, and Number of ART interruptions were statistically significant when other variables were accounted for in the model over the 18 months of follow up. BMI and WHO clinical stage were less statistically significant.
VL  - 3
IS  - 3
ER  -

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Author Information

Mosioma Philip Nyaribo

Institute of Tropical and Infectious Diseases, College of Health Sciences, University of Nairobi, Nairobi, Kenya
Otundo Denis Orare

Institute of Tropical and Infectious Diseases, College of Health Sciences, University of Nairobi, Nairobi, Kenya
Wambura Francis Muchiri

Kenya Medical Training College, Department of Health Education & Promotion, Lamu, Kenya
Chimbevo Mwagandi Lenny

School of Health Sciences, Kirinyaga University, Kerugoya, Kenya
Mutkuka John Kyalo

Kenya Medical Training College, Department of Health Education & Promotion, Nairobi, Kenya
Wang’ombe Anne

Institute of Tropical and Infectious Diseases, College of Health Sciences, University of Nairobi, Nairobi, Kenya

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APA Style

Mosioma Philip Nyaribo, Otundo Denis Orare, Wambura Francis Muchiri, Chimbevo Mwagandi Lenny, Mutkuka John Kyalo, et al. (2017). Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 3(3), 28-35. https://doi.org/10.11648/j.ijhpebs.20170303.12

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ACS Style

Mosioma Philip Nyaribo; Otundo Denis Orare; Wambura Francis Muchiri; Chimbevo Mwagandi Lenny; Mutkuka John Kyalo, et al. Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2017, 3(3), 28-35. doi: 10.11648/j.ijhpebs.20170303.12

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AMA Style

Mosioma Philip Nyaribo, Otundo Denis Orare, Wambura Francis Muchiri, Chimbevo Mwagandi Lenny, Mutkuka John Kyalo, et al. Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents. Int J HIV/AIDS Prev Educ Behav Sci. 2017;3(3):28-35. doi: 10.11648/j.ijhpebs.20170303.12

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@article{10.11648/j.ijhpebs.20170303.12,
  author = {Mosioma Philip Nyaribo and Otundo Denis Orare and Wambura Francis Muchiri and Chimbevo Mwagandi Lenny and Mutkuka John Kyalo and Wang’ombe Anne},
  title = {Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {3},
  number = {3},
  pages = {28-35},
  doi = {10.11648/j.ijhpebs.20170303.12},
  url = {https://doi.org/10.11648/j.ijhpebs.20170303.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20170303.12},
  abstract = {Human immunodeficiency virus (HIV) causes acquired immune deficiency syndrome (AIDS), a pandemic causing millions of deaths each year. Management of HIV/AIDS patients rely on antiretroviral treatment (ART) to suppress viral replication and increase CD4+ T-lymphocytes levels and time to disease progression in order to enjoy health lives and reduce transmission of the virus. CD4+ count is an essential tool for initiating and monitoring of ART. CD4+ response depend on; environmental setting where treatment is being offered, individual and population characteristics including; adherence, age, gender, baseline CD4+ cell count and viral load and individuals Basal Metabolic Index (BMI), a measure of patient’s nutritional status. This study attempts to provide an updated and clear association of independent variables predicting patient’s CD4+ immune reconstitution. This was a retrospective longitudinal study of ART-naive, HIV-infected adults and adolescents initiated on standard first line ART regimen and their CD4+ response followed up for 18 months. Study population included adults and adolescents registered and initiated on standard first line ART regimen, as part of routine comprehensive care program of the Kenyan Government in conjunction with donor partners; USAID, ICAP and EGPAF at Masaba-North Sub-County PSC/CCC. Data obtained within the study period of four years; 2012 to 2015 was analyzed statistical using multilevel mixed effect linear models in STATA for BMI categories of CD4+ level intercept values and other variables coefficients and compared to their reference groups to obtain P values. Repeated measures of ANOVA were used to determine differences in CD4+ mean response between the four intervals of measurement. Results from the study indicate that BMI is an independent predictor of CD4+ lymphocytes immune reconstitution for patients on ART. Age, Gender, and Number of ART interruptions were statistically significant when other variables were accounted for in the model over the 18 months of follow up. BMI and WHO clinical stage were less statistically significant.},
 year = {2017}
}

Copy | Download

TY  - JOUR
T1  - Association of Pre-Antiretroviral Treatment Body Mass Index with Cd4+ T-Lymphocyte Immune Reconstitution Among HIV-Infected Adults and Adolescents
AU  - Mosioma Philip Nyaribo
AU  - Otundo Denis Orare
AU  - Wambura Francis Muchiri
AU  - Chimbevo Mwagandi Lenny
AU  - Mutkuka John Kyalo
AU  - Wang’ombe Anne
Y1  - 2017/09/26
PY  - 2017
N1  - https://doi.org/10.11648/j.ijhpebs.20170303.12
DO  - 10.11648/j.ijhpebs.20170303.12
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 28
EP  - 35
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20170303.12
AB  - Human immunodeficiency virus (HIV) causes acquired immune deficiency syndrome (AIDS), a pandemic causing millions of deaths each year. Management of HIV/AIDS patients rely on antiretroviral treatment (ART) to suppress viral replication and increase CD4+ T-lymphocytes levels and time to disease progression in order to enjoy health lives and reduce transmission of the virus. CD4+ count is an essential tool for initiating and monitoring of ART. CD4+ response depend on; environmental setting where treatment is being offered, individual and population characteristics including; adherence, age, gender, baseline CD4+ cell count and viral load and individuals Basal Metabolic Index (BMI), a measure of patient’s nutritional status. This study attempts to provide an updated and clear association of independent variables predicting patient’s CD4+ immune reconstitution. This was a retrospective longitudinal study of ART-naive, HIV-infected adults and adolescents initiated on standard first line ART regimen and their CD4+ response followed up for 18 months. Study population included adults and adolescents registered and initiated on standard first line ART regimen, as part of routine comprehensive care program of the Kenyan Government in conjunction with donor partners; USAID, ICAP and EGPAF at Masaba-North Sub-County PSC/CCC. Data obtained within the study period of four years; 2012 to 2015 was analyzed statistical using multilevel mixed effect linear models in STATA for BMI categories of CD4+ level intercept values and other variables coefficients and compared to their reference groups to obtain P values. Repeated measures of ANOVA were used to determine differences in CD4+ mean response between the four intervals of measurement. Results from the study indicate that BMI is an independent predictor of CD4+ lymphocytes immune reconstitution for patients on ART. Age, Gender, and Number of ART interruptions were statistically significant when other variables were accounted for in the model over the 18 months of follow up. BMI and WHO clinical stage were less statistically significant.
VL  - 3
IS  - 3
ER  -

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