As current CD4 and duration on ART increased and viral load suppression occurred explored the interactive relationship between CD4 count, viral load and time on .. Therefore the main goals of ART are to get patients onto treatment early. A CD4 count and viral load test are performed to determine the status of a person's Goals of Viral Suppression This cause-effect relationship is the reason adherence should always be checked before therapy is changed. The complex relationship between CD4 count, HIV viral load, .. isolate the immunological effect of a low CD4 count , the presumed goal of.
Twenty in-depth interviews were conducted to assess patient perception of quality of life and factors influencing quality of life. There was no association found between change in CD4 count and quality of life scores at univariate and multivariate analysis among the study participants whether on or not on antiretroviral therapy.
Participants perceived quality of life as happiness and well-being, influenced by economic status, psychosocial factors, and health status. Conclusions Clinicians and policy makers cannot rely on change in immunological markers to predict quality of life in this era of initiating antiretroviral therapy among relatively healthy patients.
In addition to monitoring immunological markers, socioeconomic and psychosocial factors should be underscored in management of HIV patients. Background There is an established relationship between immunological and virological outcomes as important markers of HIV disease progression and treatment failure [ 12 ].
CD4 cell count has been reported to have a strong association with progression to AIDS-related illness or death [ 3 ].
Quality of life QoL has become an important outcome variable to be monitored, in addition to other clinical outcomes and biological markers such as CD4 count [ 4 ]. With the prolonged survival of HIV patients in resource-limited settings, the focus in HIV care is no longer only on clinical outcomes such as morbidity and mortality but on QoL as well. QoL measurement is now more essential than ever, to optimize patient outcomes [ 4 ].
However, it is not clear how QoL and CD4 count are related, with few studies and inconsistent results. Understanding the relationship between immunological response and QoL will improve the effectiveness, receptiveness and accuracy of care and other support services to PLHIV in resource-limited settings. Some studies have looked at factors associated with QoL, including CD4 count in developed and developing count [ 5 — 12 ].
Baseline CD4 count has been found to be a predictor of health-related QoL [ 14 ]. Another cross-sectional study reported that improving CD4 count is likely to also improve health-related QoL [ 15 ]. A CD4 count is a blood test to check the amount of CD4 cells in the body. CD4 cells are a type of white blood cell WBC.
They play a key role in the immune system. They alert other immune cells to the presence of infections such as bacteria and other viruses in the body. CD4 cells are also a subset of immune cells called T cells. This process damages CD4 cells and causes the number of them in the body to drop, making it difficult to fight infections.
CD4 counts show the robustness of the immune system. What is a viral load?
2.14 How CD4 and viral load are related
Viral loads are generally highest for a period right after contracting HIV. A viral load can include millions of copies per mL of blood, especially when the virus is first contracted.
A low viral load indicates relatively few copies of HIV in the blood. If an HIV treatment plan is effective, a person will be able to maintain a lower viral load. However, in general, a high CD4 count and a low — or undetectable — viral load are desirable.
How CD4 and viral load are related | Training manual | HIV i-Base
The higher the CD4 count, the healthier the immune system. First-line ART regimens before April consisted of stavudine or zidovudine with lamivudine and either efavirenz or nevirapine [ 28 ].
Tenofovir was substituted for stavudine after April [ 29 ]. After treatment has begun, patients are seen for follow-up visits and antiretroviral drug pickups monthly for the first 6—12 months on treatment, then every 2 months thereafter if stable.
Study population We performed a cohort analysis of data collected prospectively as part of routine care at the Themba Lethu clinic.
Patients included contributed both a CD4 count and a viral load measure during at least one month time period. We excluded pregnant women as they are initiated on ART at higher average CD4 counts and have variable CD4 counts compared to the general population [ 30 ]. Study Variables The primary outcome for this study was death. Eligible patients contributed person-time from the date of ART initiation until the date of the earliest of: For analysis we divided person-time for each subject into month periods starting from ART initiation.
For each month period a patient contributed one observation indicating whether death occurred, current viral load and current CD4 cell count. Subjects could contribute multiple observations to the analysis but not in the same time period.
All other covariates were fixed at ART initiation in this analysis. Data Analyses Patient baseline characteristics were summarized with descriptive statistics stratified by vital status. To estimate the risk of death as a function of current viral load status, current CD4 count and time on ART, we included multiple observations for each patient indicating their updated exposures and outcome status. Since we are interested in estimating absolute risks and not survival, we modeled one-year and overall risk of death as a log-linear function of these covariates using two different models, each using a Poisson distribution [ 36 ].