ABSTRACT
Background: Interleukin-10; IL-2 and IFN -? are some of the crucial cytokines associated with HIV infection and pathogenesis. While IL-2 and IFN-? play critical roles in host resistance to infection; IL-10 inhibits the synthesis IFN-?; IL-2 at mRNA and protein level; exacerbating damage to immune system. Objective: To determine the levels of; changes in and correlation between CD4 count; viral load; IL-10; IL-2 and IFN-? before HAART and at six months of HAART among HIV positive patients in Kigali; with a view to understand cytokine networks particularly in relation to HAART ; and to see whether they can be used as alternative markers of the disease progression. Design: Longitudinal study. Setting: Kagugu; Kimironko; Biryogo; Gitega Health Centres and Centre Medico-Social Cornum; all located in Kigali. Subjects: Thirty three (33) HAART initiation eligible HIV positive patients including 13 women and 20 men. Results: A drop in viral load (though only a small number of patients achieved an undetectable viraemia); a recovery of CD4+ cells; a decrease in IL-10 (though it remained high for many patients especially those with unchanged viraemia); and an increase in IL-2 and IFN-? indicated a successful HAART . A negative correlation between CD4 count and viral load and between CD4 count and IL-10 (but r -0.5) was observed. IL-10 correlated positively and strongly with viremia (r 0.5 at both time points: p-values 0.05). There was no significant correlation between CD4 count; IL-2 and IFN-?. Conclusion: Results demonstrated the down-regulatory effect of IL-10 on Th1 cytokines and that a shift from Th1 to Th2 cytokine is associated with HIV disease progression. A successful HAART results in CD4+ cells recovery; drop in viraemia and IL-10 with up-regulation of Th1 cytokines. Also; findings show potential usefulness of IL-10 as a marker of HIV disease progression
Subject(s)
HIV Seropositivity/immunologyABSTRACT
Objective:To estimate rates of completion of CD4+ lymphocyte testing (CD4 testing) within 12 weeks of testing positive for human immunodeficiency virus (HIV) at a large HIV/AIDS clinic in South Africa, and to identify clinical and demographic predictors for completion.Methods:In our study, CD4 testing was considered complete once a patient had retrieved the test results. To determine the rate of CD4 testing completion, we reviewed the records of all clinic patients who tested positive for HIV between January 2008 and February 2009. We identified predictors for completion through multivariate logistic regression.Findings:Of the 416 patients who tested positive for HIV, 84.6% initiated CD4 testing within the study timeframe. Of these patients, 54.3% were immediately eligible for antiretroviral therapy (ART) because of a CD4 cell count ⤠200/µl, but only 51.3% of the patients in this category completed CD4 testing within 12 weeks of HIV testing. Among those not immediately eligible for ART (CD4 cells > 200/µl), only 14.9% completed CD4 testing within 12 weeks. Overall, of HIV+ patients who initiated CD4 testing, 65% did not complete it within 12 weeks of diagnosis. The higher the baseline CD4 cell count, the lower the odds of completing CD4 testing within 12 weeks.Conclusion:Patient losses between HIV testing, baseline CD4 cell count and the start of care and ART are high. As a result, many patients receive ART too late. Health information systems that link testing programmes with care and treatment programmes are needed