Long Term CD4 Count Increase in Routine Clinical Practice, Abidjan, Côte d’Ivoire

Background and objective: There are limited data on long term immune response to antiretroviral therapy delivered in routine conditions in sub-Saharan Africa. Accordingly, we conducted this retrospective cohort study to analyse long term immune response among HIV-positive patients receiving ART in routine clinical practice in Côte d'Ivoire. Methods: The analyses included 2,568 adolescent and adult patients who initiated antiretroviral therapy between 1998 and 2013. CD4 count increase was estimated using generalized estimating equations for repeated measurements. Linear functions of the parameters based on the coefficients of linear contrast were used to estimate the slopes of CD4 gain. Results: Almost 84% of the patients have received a Nevirapine or Efavirenz-based regimen at ART initiation. Median time (Interquartile range) under treatment was 3.44 (0.99–7.00) years and 34.6% patients were lost to follow-up. CD4 count increased consistently over time (p-value for linear trend<0.0001) and median cumulative increase (Interquartile range) was 509.4 (196.5–659.3) cells/mm3 at month-144. Immune response was strong among patients starting ART with baseline CD4 counts ≤ 350/mm3 and women. Overall, 132 patients underwent at least one episode of clinical and/or immunological failure. These episodes occurred mainly (53%) among severely immuno-depressed patients (0–100 CD4/mm3 ). The overall crude mortality rate (95% Confidence interval) was 0.88 (0.71–1.06) per 100 person-years. Conclusion: Sustained gains in CD4 count can be achieved in HIV-positive people remaining under care in routine clinical practice in subSaharan Africa.