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

摘要

IntroductionPast endeavours to deal with the obstacle of expensive Cluster of Difference 4 (CD4sup+/sup) count diagnostics in resource-limited settings have left a long trail of suggested continuous CD4sup+/sup 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 CD4sup+/sup count covariates has not been well documented. MethodsThe 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 CD4sup+/sup 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 CD4sup+/sup count covariates. ResultsOnly 18 of the 46 investigated clinical attributes were the strongest CD4sup+/sup count covariates and the top 8 were positively and independently associated with the CD4sup+/sup 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. ConclusionOnly a few of the many previously suggested continuous CD4sup+/sup 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 CD4sup+/sup cell response has the potential to delay challenges associated with ART side effects.