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Infectious Diseases and Therapy
Published in: Infectious Diseases and Therapy 2/2019

Open Access 01-06-2019 | Human Immunodeficiency Virus | Original Research

An Evaluation to Determine the Strongest CD4 Count Covariates during HIV Disease Progression in Women in South Africa

Authors: Partson Tinarwo, Temesgen Zewotir, Nonhlanhla Yende-Zuma, Nigel J. Garrett, Delia North

Published in: Infectious Diseases and Therapy | Issue 2/2019

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Abstract

Introduction

Past endeavours to deal with the obstacle of expensive Cluster of Difference 4 (CD4+) count diagnostics in resource-limited settings have left a long trail of suggested continuous CD4+ count clinical covariates that turned out to be a potentially important integral part of the human immunodeficiency virus (HIV) treatment process during disease progression. However, an evaluation to determine the strongest candidates among these CD4+ count covariates has not been well documented.

Methods

The Centre for the AIDS Programme of Research in South Africa (CAPRISA) initially enrolled HIV-negative (phase 1) patients into different study cohorts. The patients who seroconverted (237) during follow-up care were enrolled again into a post-HIV infection cohort where they were further followed up with weekly to fortnightly visits up to 3 months (phase 2: acute infection), monthly visits from 3–12 months (phase 3: early infection) and quarterly visits thereafter (phase 4: established infection) until antiretroviral therapy (ART) initiation (phase 5). The CD4+ count and 46 covariates were repeatedly measured at each phase of the HIV disease progression. A multilevel partial least squares approach was applied as a variable reduction technique to determine the strongest CD4+ count covariates.

Results

Only 18 of the 46 investigated clinical attributes were the strongest CD4+ count covariates and the top 8 were positively and independently associated with the CD4+ count. Besides the confirmatory lymphocytes, these were basophils, albumin, haematocrit, alkaline phosphatase (ALP), mean corpuscular volume (MCV), platelets, potassium and monocytes. Overall, electrolytes, proteins and red blood cells were the dominant categories for the strongest covariates.

Conclusion

Only a few of the many previously suggested continuous CD4+ count clinical covariates showed the potential to become an important integral part of the treatment process. Prolonging the pre-treatment period of the HIV disease progression by effectively incorporating and managing the covariates for long-term influence on the CD4+ cell response has the potential to delay challenges associated with ART side effects.
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Metadata
Title
An Evaluation to Determine the Strongest CD4 Count Covariates during HIV Disease Progression in Women in South Africa
Authors
Partson Tinarwo
Temesgen Zewotir
Nonhlanhla Yende-Zuma
Nigel J. Garrett
Delia North
Publication date
01-06-2019
Publisher
Springer Healthcare
Published in
Infectious Diseases and Therapy / Issue 2/2019
Print ISSN: 2193-8229
Electronic ISSN: 2193-6382
DOI
https://doi.org/10.1007/s40121-019-0235-4

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