Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

Nasir Tajure Wabe; Mohammed Alemu

Kuzey Batı Etiyopya'da yüksek etkili antiretroviral tedavi alan HIV-enfekte hastaların immünolojik ve klinik gelişimi

Year 2012, Volume: 18 Issue: 1, 31 - 36, 01.02.2012

Abstract

The survival benefits of highly active antiretroviral therapy (HAART) in HIV infected patients have been studied well in the developed world. In resource poor settings like Ethiopia such treatment was started only in 2003. As a result, the existing treatment guidelines and recommendations are based on data from the developed world. The objective of this study was to determine the immunological and clinical progress in HIV/AIDS patients in one year data review of patients' card who initiated on HAART in Ethiopia. A retrospective cohort study was done based on past medical records of HIV/AIDS patients, using a structured data collection format. All patient cards of one year data with patients who initiated HAART from October 1, 2006 to November 30, 2007 were included in the study. The data collected was analyzed using SPSS for window version 16.0. The majority of the study population (383, 64.2%) were prescribed zidovudine/lamivudine/neverapine (ZDV/3TC/NVP) regimen initially. Overall functional status change showed that ability to work was increased by 31.5%, being ambulatory decreased by 93.4% and bedridden status decreased by 80%. A total of 240 (46.9%) patients have showed functional status improvement. Average mean weight change of 5.9 kg (increment by 11.9%) was seen during a one year follow-up. The patients showed immunological change from 132.883 mean CD4/mm3 count to 335.87 mean CD4/mm3. About 492 (82.4%) patients present with different type of opportunistic infections (OIs) at start of therapy which dramatically dropped to only 40 (6.7%) patient after one year of receiving HAART. HAART initiation has decreased progression of the diseases and improved the patients' quality of life. Most patients have showed a significant increment in their CD4 count. The restoration of CD4 in turn has improved the clinical status of most patients. Despite the significant progression of health of patients, greater immunological and clinical success should be attained by encouraging patients for effective use of those lifesaving drugs with maximal adherence.

Keywords

HIV, Antigens, CD4, Antiretroviral Therapy, Highly Active, Ethiopia

References

1. Berhane Y, Mekonnen Y, Seyoum E, Gelmon L, Wilson D. HIV / AIDS in Ethiopia – An Epidemiological Synthesis. Ethiopia HIV/AIDS Prevention & Control Office (HAPCO) and Global HIV/AIDS Monitoring and Evaluation Team (GAMET). The Global HIV/AIDS Program 2008.
2. Grabar S, Kousignian I, Sobel A, Le Bras P, Gasnault J, Enel P, et al. Immunologic and clinical responses to highly active antiretroviral therapy over 50 years of age. Results from the French Hospital Database on HIV. AIDS 2004;18(15):2029-38.
3. Grabar S, Le Moing V, Goujard C, Leport C, Kazatchkine MD, Costagliola D, et al. Clinical outcome of patients with HIV-1 Infection according to immunologic and virologic response after 6 months of highly active antiretroviral therapy. Ann Intern Med 2000;133(6):401-10.
4. Hogg RS, Heath KV, Yip B, Craib KJ, O'Shaughnessy MV, Schechter MT, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA 1998;279(6):450-54.
5. Egger M, May M, Chêne G, Phillips AN, Ledergerber B, Dabis F, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002; 360(9327):119-29. Erratum in: Lancet 2002;360(9340):1178.
6. Kaufmann GR, Zaunders JJ, Cunningham P, Kelleher AD, Grey P, Smith D, et al. Rapid restoration of CD4 T cell subsets in subjects receiving antiretroviral therapy during primary HIV-1 infection. AIDS 2000;14(17):2643-51.
7. Ledergerber B, Egger M, Erard V, Weber R, Hirschel B, Furrer H, et al. AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study. JAMA 1999;282(23):2220-6.
8. Mocroft A, Vella S, Benfield TL, Chiesi A, Miller V, Gargalianos P, et al. Changing patterns of mortality across Europe in patients infected with HIV-1. EuroSIDA Study Group. Lancet 1998;352(9142):1725-30.
9. Yamashita TE, Phair JP, Munoz A, Margolick JB, Detels R, O’Brien SJ, et al. Immunologic and virologic response to highly active antiretroviral therapy in the Multicenter AIDS Cohort Study. AIDS 2001;15(6):735-46.
10. Palella FJ Jr., Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998;338(13):853-60.
11. Schmidt-Westhausen AM, Priepke F, Bergman FJ, Reichart PA. Decline in the rate of oral opportunistic infections following introduction of highly active retroviral therapy. J Oral Pathol Med 2000;29(7):336-41.
12. Mellors JW, Munoz A, Giorgi JV, Margolick JB, Tassoni CJ, Gupta P, et al. Plasma viral load CD41 lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med 1997;126(12):946-54.
13. Wintergerst U, Hoffmann F, Sölder B, Notheis G, Petropoulou T, Eberle J, et al. Comparison of two antiretroviral triple combinations including the protease inhibitor indinavir in children infected with human immunodeficiency virus. Pediatr Infect Dis J 1998;17(6):495-9.
14. Mueller BU, Nelson RP Jr, Sleasman J, Zuckerman J, HeathChiozzi M, Steinberg SM, et al. A phase I/II study of the protease inhibitor ritonavir in children with human immunodeficiency virus infection. Pediatrics 1998;101(3 Pt 1):335-43.
15. Wiznia A, Stanley K, Krogstad P, Johnson G, Lee S, McNamara J, et al. Combination nucleoside analog reverse transcriptase inhibitor(s) plus nevirapine, nelfinavir, or ritonavir in stable antiretroviral therapy-experienced HIV-infected children: week 24 results of a randomized controlled trial—PACTG 377.
Pediatric AIDS Clinical Trials Group 377 Study Team. AIDS Res Hum Retroviruses 2000;16(12):1113-21.
16. Rutstein RM, Feingold A, Meislich D, Word B, Rudy B. Protease inhibitor therapy in children with perinatally acquired HIV infection. AIDS 1997;11(12):F107-11.
17. Hughes MD, Daniels MJ, Fischl MA, Kim S, Schooley RT. CD4 cell count as a surrogate endpoint in HIV clinical trials: a meta-analysis of studies of the AIDS Clinical Trials Group. AIDS 1998;12(14):1823-32.
18. Street E, Curtis H, Sabin CA, Monteiro EF, Johnson MA. British HIV Association (BHIVA) and BHIVA Audit and Standards Subcommittee. British HIV Association (BHIVA) national cohort outcomes audit of patients commencing antiretrovirals from naïve. HIV Med 2009;10(6):337-42.
19. Tan R, Westfall AO, Willig JH, Mugavero MJ, Saag MS, Kaslow RA, et al. Clinical outcome of HIV-infected antiretroviral-naive patients with discordant immunologic virologic responses to highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2008;47(5):553-8.
20. Robbins GK, Spritzler JG, Chan ES, Asmuth DM, Gandhi RT, Rodriguez BA, et al. Incomplete reconstitution of T cell subsets on combination antiretroviral therapy in the AIDS Clinical Trials Group protocol 384. Clin Infect Dis 2009;48(3):350-61.
21. Volberding PA, Deeks SG. Antiretroviral therapy for HIV infection: promises and problems. JAMA 1998; 279(17):1343-4.
22. Autran B, Carcelain G, Li TS, Blanc C, Mathez D, Tubiana R, et al. Positive effects of combined antiretroviral therapy on CD4+ T cell homeostasis and function in advanced HIV disease. Science 1997;277(5322):112-6.
23. Jerene D, Naess A, Lindtjørn B. Antiretroviral therapy at a district hospital in Ethiopia prevents death and tuberculosis in a cohort of HIV patients. AIDS Res Ther 2006;3:10.
24. Touloumi G, Paparizos V, Sambatakou H, Katsarou O, Chrysos G, Kordossis T, et al. Virological and immunological response to HAART therapy in a community-based cohort of HIV-1- positive individuals. HIV Clin Trials 2001;2(1):6-16.
25. Powderly WG, Saag MS, Chapman S, Yu G, Quart B, Clendeninn NJ. Predictors of optimal virological response to potent antiretroviral therapy. AIDS 1999;13(14):1873-80.
26. Pialoux G, Raffi F, Brun-Vezinet F, Meiffrédy V, Flandre P, Gastaut JA, et al. A randomized trial of three maintenance regimens given after three months of induction therapy with zidovudine, lamivudine, and indinavir in previously untreated HIV-1 infected patients. Trilège (Agence Nationale de Recherches sur le SIDA 072) Study Team. N Engl J Med 1998;339(18):1269-76.
27. Descamps D, Flandre P, Calvez V, Peytavin G, Meiffredy V, Collin G, et al. Mechanisms of virologic failure in previously untreated HIV-infected patients from a trial of inductionmaintenance therapy. Trilège (Agence Nationale de Recherches sur le SIDA 072) Study Team. JAMA 2000;283(2):205-11. Erratum in: JAMA 2000;284(12):1518.
28. BHIVA Guidelines Coordinating Committee. British HIV Association guidelines for aniretroviral treatment of HIV seropositive individuals. Lancet 1997;349(9058):1086-92.
29. Havlir DV, Marschner IC, Hirsch MS, Collier AC, Tebas P, Bassett RL, et al. Maintenance antiretroviral therapies in HIV infected patients with undetectable plasma HIV RNA after triple-drug therapy. AIDS Clinical Trials Group Study 343 Team. N Engl J Med 1998;339(18):1261-8.
30. Levitz S. Improvement in CD4+ cell counts despite persistently detectable HIV load. N Engl J Med 1998; 338(15):1074-5. 31. Perrin L, Telenti A. HIV treatment failure: testing for HIV resistance in clinical practice. Science 1998; 280(5371):1871-3.
32. Barreiro PM, Dona MC, Castilla J, Soriano V. Patterns of response (CD4 cell count and viral load) at 6 months in HIVinfected patients on highly active antiretroviral tharpy. AIDS 1999;13(4):525-6.
33. Wit FW, van Leeuwen R, Weverling GJ, Jurriaans S, Nauta K, Steingrover R, et al. Outcome and predictors of failure of highly active antiretroviral therapy: one-year follow-up of a cohort of human immunodeficiency virus type 1-infected persons. J Infect Dis 1999;179(4):790-8.
34. Staszewski S, Miller V, Sabin C, Schlecht C, Gute P, Stamm S, et al. Determinants of sustainable CD4 lymphocyte count increases in response to antiretroviral therapy. AIDS 1999; 13(8):951-6.
35. Akileswaran C, Lurie MN, Flanigan TP, Mayer KH. Lessons learned from use of highly active antiretroviral therapy in Africa. Clin Infect Dis 2005;41(3):376-85.
36. Loupa CV, Rodriguez B, McComsey G, Gripshover B, Salata RA, Valdez H, et al. Gender differences in human immunodeficiency virus (HIV) RNA and CD4 cell counts among new entrants to HIV care. Clin Microbiol Infect 2006;12(4):389-91.
37. Nicastri E, Angeletti C, Palmisano L, Sarmati L, Chiesi A, Geraci A, et al. Gender differences in clinical progression of HIV-1-infected individuals during long-term highly active antiretroviral therapy. AIDS 2005;19(6):577-83.
38. Moore AL, Mocroft A, Madge S, Devereux H, Wilson D, Phillips AN, et al. Gender differences in virologic response to treatment in an HIV-positive population: a cohort study. J Acquir Immune Defic Syndr 2001;26(2):159-63.
39. Saves M, Morlat P, Chene G, Dumon B, Peuchant E. Sex differences in HIV-1 viral load and TNF-alpha plasmatic level? AIDS 1999;13(11):1414-5.
40. Sterling TR, Vlahov D, Astemborski J, Hoover DR, Margolick JB, Quinn TC. Initial plasma HIV-1 RNA levels and progression to AIDS in women and men. N Engl J Med 2001;344(10):720-5.
41. Anastos K, Gange SJ, Lau B, Weiser B, Detels R, Giorgi JV, et al. Association of race and gender with HIV-1 RNA levels and immunologic progression. J Acquir Immune Defic Syndr 2000;24(3):218-26.
42. Prins M, Robertson JR, Brettle RP, Aguado IH, Broers B, Boufassa F, et al. Do gender differences in CD4 cell counts matter? AIDS 1999;13(17):2361-4.
43. Finkel DG, John G, Holland B, Slim J, Smith SM. Women have a greater immunological response to effective virological HIV-1 therapy. AIDS 2003;17(13):2009-11.
44. Clark RA, Squires KE. Gender-specific considerations in the antiretroviral management of HIV-infected women. Expert Rev Anti-infect Ther 2005;3(2):213-27.
45. Uppal SS, Verma S, Dhot PS. Normal values of CD4 and CD8 lymphocyte subsets in healthy indian adults and the effects of sex, age, ethnicity, and smoking. Cytometry B Clin Cytom 2003;52(1):32-6.
46. Zhang FJ, Maria A, Haberer J, Zhao Y. Overview of HIV drug resistance and its implications for China. Chin Med J (Engl) 2006;119(23):1999-2004.
47. Collazos J, Asensi V, Cartón JA. Sex differences in the clinical, immunological and virological parameters of HIV-infected patients treated with HAART. AIDS 2007;21(7):835-43.
48. Ofotokun I. Sex differences in the pharmacologic effects of antiretroviral drugs: potential roles of drug transporters and phase 1 and 2 metabolizing enzymes. Top HIV Med 2005;13(2):79-83.
49. Gandhi M, Aweeka F, Greenblatt RM, Blaschke TF. Sex differences in pharmacokinetics and pharmacodynamics. Annu Rev Pharmacol Toxicol 2004; 44:499-523.

Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

Year 2012, Volume: 18 Issue: 1, 31 - 36, 01.02.2012

Nasir Tajure Wabe Mohammed Alemu

Abstract

HIV ile enfekte hastalarda yüksek etkili antiretroviral tedavinin (HAART, higly active antiretroviral therapy) yaşam üzerindeki faydaları gelişmiş ülkelerde çok çalışılmıştır. Etiyopya gibi kaynakları kısıtlı yerlerde bu gibi tedavi 2003'de başladı. Sonuç olarak, var olan tedavi kılavuzları ve tavsiyeler gelişmiş ülkedeki verilere dayanmaktadır. Bu çalışmanın amacı, Etiyopya'da HAART tedavisine başlanan hasta kartlarındaki bir yıllık veri incelenerek HIV/AIDS hastalarının immünolojik ve klinik gelişimi saptamaktı. Retrospektif kohort çalışma, yapılandırılmış veri toplama formatı kullanılarak HIV/AIDS hastalarının geçmişteki tıbbi kayıtlarına dayanarak yapıldı. 1 Ekim 2006'dan 30 Kasım 2007'ye kadar HAART tedavisi başlanan hastaların kartlarındaki bir yıllık veriler çalışmaya alındı. Toplanan veriler SPSS for Windows sürüm 16.0 kullanılarak analiz edildi. Çalışılan popülasyonun büyük çoğunluğu (383, %64.2) başlangıçta zidovudin/lamivudin/neverapin (ZDV/3TC/NVP) tedavisi verilmişti. Genelde fonksiyonel durum değişimi, çalışma yeteneğinin %31.5 arttığını, ayakta tedavi edilmenin %93.4 azaldığını, yatağa bağlı kalma durumunun %80 azaldığını gösterdi. Toplam 240 hasta fonksiyonel durum düzelmesi gösterdi. Bir yıllık izleme sırasında 5.9 kg ortalama ağırlık değişimi (%11.9 artma) gözlendi. Hastalar ortalama 132.883 CD4/mm3 sayımından ortalama 335.87 CD4/mm3'e immünolojik değişim gösterdi. Tedavinin başlamasında farklı tipte fırsatçı enfeksiyonu bulunan yaklaşık 492 (%82.4) hasta, HAART tedavisi başlamasından bir yıl sonra dramatik olarak sadece 40'a (%6.7) düştü. HAART tedavisi başlanması hastalığın ilerlemesini azalttı ve hastaların yaşam kalitesini iyileştirdi. Hastaların çoğu CD4 sayılarında anlamlı artışlar gösterdi. CD4'deki düzelme birçok hastanın klinik durumunu iyileştirdi. Hastaların sağlığındaki anlamlı iyileşmeye karşın, hayat kurtaran bu ilaçlara daha fazla etkin kullanılması için hastaların teşvik edilmesi ile daha fazla immünolojik ve klinik başarı elde edilmelidir.

Keywords

HIV, Antijenler, CD4, Antiretroviral sağaltım, yüksek etkili, Etiyopya

References

1. Berhane Y, Mekonnen Y, Seyoum E, Gelmon L, Wilson D. HIV / AIDS in Ethiopia – An Epidemiological Synthesis. Ethiopia HIV/AIDS Prevention & Control Office (HAPCO) and Global HIV/AIDS Monitoring and Evaluation Team (GAMET). The Global HIV/AIDS Program 2008.
2. Grabar S, Kousignian I, Sobel A, Le Bras P, Gasnault J, Enel P, et al. Immunologic and clinical responses to highly active antiretroviral therapy over 50 years of age. Results from the French Hospital Database on HIV. AIDS 2004;18(15):2029-38.
3. Grabar S, Le Moing V, Goujard C, Leport C, Kazatchkine MD, Costagliola D, et al. Clinical outcome of patients with HIV-1 Infection according to immunologic and virologic response after 6 months of highly active antiretroviral therapy. Ann Intern Med 2000;133(6):401-10.
4. Hogg RS, Heath KV, Yip B, Craib KJ, O'Shaughnessy MV, Schechter MT, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA 1998;279(6):450-54.
5. Egger M, May M, Chêne G, Phillips AN, Ledergerber B, Dabis F, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002; 360(9327):119-29. Erratum in: Lancet 2002;360(9340):1178.
6. Kaufmann GR, Zaunders JJ, Cunningham P, Kelleher AD, Grey P, Smith D, et al. Rapid restoration of CD4 T cell subsets in subjects receiving antiretroviral therapy during primary HIV-1 infection. AIDS 2000;14(17):2643-51.
7. Ledergerber B, Egger M, Erard V, Weber R, Hirschel B, Furrer H, et al. AIDS-related opportunistic illnesses occurring after initiation of potent antiretroviral therapy: the Swiss HIV Cohort Study. JAMA 1999;282(23):2220-6.
8. Mocroft A, Vella S, Benfield TL, Chiesi A, Miller V, Gargalianos P, et al. Changing patterns of mortality across Europe in patients infected with HIV-1. EuroSIDA Study Group. Lancet 1998;352(9142):1725-30.
9. Yamashita TE, Phair JP, Munoz A, Margolick JB, Detels R, O’Brien SJ, et al. Immunologic and virologic response to highly active antiretroviral therapy in the Multicenter AIDS Cohort Study. AIDS 2001;15(6):735-46.
10. Palella FJ Jr., Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998;338(13):853-60.
11. Schmidt-Westhausen AM, Priepke F, Bergman FJ, Reichart PA. Decline in the rate of oral opportunistic infections following introduction of highly active retroviral therapy. J Oral Pathol Med 2000;29(7):336-41.
12. Mellors JW, Munoz A, Giorgi JV, Margolick JB, Tassoni CJ, Gupta P, et al. Plasma viral load CD41 lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med 1997;126(12):946-54.
13. Wintergerst U, Hoffmann F, Sölder B, Notheis G, Petropoulou T, Eberle J, et al. Comparison of two antiretroviral triple combinations including the protease inhibitor indinavir in children infected with human immunodeficiency virus. Pediatr Infect Dis J 1998;17(6):495-9.
14. Mueller BU, Nelson RP Jr, Sleasman J, Zuckerman J, HeathChiozzi M, Steinberg SM, et al. A phase I/II study of the protease inhibitor ritonavir in children with human immunodeficiency virus infection. Pediatrics 1998;101(3 Pt 1):335-43.
15. Wiznia A, Stanley K, Krogstad P, Johnson G, Lee S, McNamara J, et al. Combination nucleoside analog reverse transcriptase inhibitor(s) plus nevirapine, nelfinavir, or ritonavir in stable antiretroviral therapy-experienced HIV-infected children: week 24 results of a randomized controlled trial—PACTG 377.
Pediatric AIDS Clinical Trials Group 377 Study Team. AIDS Res Hum Retroviruses 2000;16(12):1113-21.
16. Rutstein RM, Feingold A, Meislich D, Word B, Rudy B. Protease inhibitor therapy in children with perinatally acquired HIV infection. AIDS 1997;11(12):F107-11.
17. Hughes MD, Daniels MJ, Fischl MA, Kim S, Schooley RT. CD4 cell count as a surrogate endpoint in HIV clinical trials: a meta-analysis of studies of the AIDS Clinical Trials Group. AIDS 1998;12(14):1823-32.
18. Street E, Curtis H, Sabin CA, Monteiro EF, Johnson MA. British HIV Association (BHIVA) and BHIVA Audit and Standards Subcommittee. British HIV Association (BHIVA) national cohort outcomes audit of patients commencing antiretrovirals from naïve. HIV Med 2009;10(6):337-42.
19. Tan R, Westfall AO, Willig JH, Mugavero MJ, Saag MS, Kaslow RA, et al. Clinical outcome of HIV-infected antiretroviral-naive patients with discordant immunologic virologic responses to highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2008;47(5):553-8.
20. Robbins GK, Spritzler JG, Chan ES, Asmuth DM, Gandhi RT, Rodriguez BA, et al. Incomplete reconstitution of T cell subsets on combination antiretroviral therapy in the AIDS Clinical Trials Group protocol 384. Clin Infect Dis 2009;48(3):350-61.
21. Volberding PA, Deeks SG. Antiretroviral therapy for HIV infection: promises and problems. JAMA 1998; 279(17):1343-4.
22. Autran B, Carcelain G, Li TS, Blanc C, Mathez D, Tubiana R, et al. Positive effects of combined antiretroviral therapy on CD4+ T cell homeostasis and function in advanced HIV disease. Science 1997;277(5322):112-6.
23. Jerene D, Naess A, Lindtjørn B. Antiretroviral therapy at a district hospital in Ethiopia prevents death and tuberculosis in a cohort of HIV patients. AIDS Res Ther 2006;3:10.
24. Touloumi G, Paparizos V, Sambatakou H, Katsarou O, Chrysos G, Kordossis T, et al. Virological and immunological response to HAART therapy in a community-based cohort of HIV-1- positive individuals. HIV Clin Trials 2001;2(1):6-16.
25. Powderly WG, Saag MS, Chapman S, Yu G, Quart B, Clendeninn NJ. Predictors of optimal virological response to potent antiretroviral therapy. AIDS 1999;13(14):1873-80.
26. Pialoux G, Raffi F, Brun-Vezinet F, Meiffrédy V, Flandre P, Gastaut JA, et al. A randomized trial of three maintenance regimens given after three months of induction therapy with zidovudine, lamivudine, and indinavir in previously untreated HIV-1 infected patients. Trilège (Agence Nationale de Recherches sur le SIDA 072) Study Team. N Engl J Med 1998;339(18):1269-76.
27. Descamps D, Flandre P, Calvez V, Peytavin G, Meiffredy V, Collin G, et al. Mechanisms of virologic failure in previously untreated HIV-infected patients from a trial of inductionmaintenance therapy. Trilège (Agence Nationale de Recherches sur le SIDA 072) Study Team. JAMA 2000;283(2):205-11. Erratum in: JAMA 2000;284(12):1518.
28. BHIVA Guidelines Coordinating Committee. British HIV Association guidelines for aniretroviral treatment of HIV seropositive individuals. Lancet 1997;349(9058):1086-92.
29. Havlir DV, Marschner IC, Hirsch MS, Collier AC, Tebas P, Bassett RL, et al. Maintenance antiretroviral therapies in HIV infected patients with undetectable plasma HIV RNA after triple-drug therapy. AIDS Clinical Trials Group Study 343 Team. N Engl J Med 1998;339(18):1261-8.
30. Levitz S. Improvement in CD4+ cell counts despite persistently detectable HIV load. N Engl J Med 1998; 338(15):1074-5. 31. Perrin L, Telenti A. HIV treatment failure: testing for HIV resistance in clinical practice. Science 1998; 280(5371):1871-3.
32. Barreiro PM, Dona MC, Castilla J, Soriano V. Patterns of response (CD4 cell count and viral load) at 6 months in HIVinfected patients on highly active antiretroviral tharpy. AIDS 1999;13(4):525-6.
33. Wit FW, van Leeuwen R, Weverling GJ, Jurriaans S, Nauta K, Steingrover R, et al. Outcome and predictors of failure of highly active antiretroviral therapy: one-year follow-up of a cohort of human immunodeficiency virus type 1-infected persons. J Infect Dis 1999;179(4):790-8.
34. Staszewski S, Miller V, Sabin C, Schlecht C, Gute P, Stamm S, et al. Determinants of sustainable CD4 lymphocyte count increases in response to antiretroviral therapy. AIDS 1999; 13(8):951-6.
35. Akileswaran C, Lurie MN, Flanigan TP, Mayer KH. Lessons learned from use of highly active antiretroviral therapy in Africa. Clin Infect Dis 2005;41(3):376-85.
36. Loupa CV, Rodriguez B, McComsey G, Gripshover B, Salata RA, Valdez H, et al. Gender differences in human immunodeficiency virus (HIV) RNA and CD4 cell counts among new entrants to HIV care. Clin Microbiol Infect 2006;12(4):389-91.
37. Nicastri E, Angeletti C, Palmisano L, Sarmati L, Chiesi A, Geraci A, et al. Gender differences in clinical progression of HIV-1-infected individuals during long-term highly active antiretroviral therapy. AIDS 2005;19(6):577-83.
38. Moore AL, Mocroft A, Madge S, Devereux H, Wilson D, Phillips AN, et al. Gender differences in virologic response to treatment in an HIV-positive population: a cohort study. J Acquir Immune Defic Syndr 2001;26(2):159-63.
39. Saves M, Morlat P, Chene G, Dumon B, Peuchant E. Sex differences in HIV-1 viral load and TNF-alpha plasmatic level? AIDS 1999;13(11):1414-5.
40. Sterling TR, Vlahov D, Astemborski J, Hoover DR, Margolick JB, Quinn TC. Initial plasma HIV-1 RNA levels and progression to AIDS in women and men. N Engl J Med 2001;344(10):720-5.
41. Anastos K, Gange SJ, Lau B, Weiser B, Detels R, Giorgi JV, et al. Association of race and gender with HIV-1 RNA levels and immunologic progression. J Acquir Immune Defic Syndr 2000;24(3):218-26.
42. Prins M, Robertson JR, Brettle RP, Aguado IH, Broers B, Boufassa F, et al. Do gender differences in CD4 cell counts matter? AIDS 1999;13(17):2361-4.
43. Finkel DG, John G, Holland B, Slim J, Smith SM. Women have a greater immunological response to effective virological HIV-1 therapy. AIDS 2003;17(13):2009-11.
44. Clark RA, Squires KE. Gender-specific considerations in the antiretroviral management of HIV-infected women. Expert Rev Anti-infect Ther 2005;3(2):213-27.
45. Uppal SS, Verma S, Dhot PS. Normal values of CD4 and CD8 lymphocyte subsets in healthy indian adults and the effects of sex, age, ethnicity, and smoking. Cytometry B Clin Cytom 2003;52(1):32-6.
46. Zhang FJ, Maria A, Haberer J, Zhao Y. Overview of HIV drug resistance and its implications for China. Chin Med J (Engl) 2006;119(23):1999-2004.
47. Collazos J, Asensi V, Cartón JA. Sex differences in the clinical, immunological and virological parameters of HIV-infected patients treated with HAART. AIDS 2007;21(7):835-43.
48. Ofotokun I. Sex differences in the pharmacologic effects of antiretroviral drugs: potential roles of drug transporters and phase 1 and 2 metabolizing enzymes. Top HIV Med 2005;13(2):79-83.
49. Gandhi M, Aweeka F, Greenblatt RM, Blaschke TF. Sex differences in pharmacokinetics and pharmacodynamics. Annu Rev Pharmacol Toxicol 2004; 44:499-523.

There are 49 citations in total.

Details

Primary Language	Turkish
Journal Section	Articles
Authors	Nasir Tajure Wabe This is me Mohammed Alemu This is me
Publication Date	February 1, 2012
Published in Issue	Year 2012 Volume: 18 Issue: 1

Cite

APA	Wabe, N. T., & Alemu, M. (2012). Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia. Gaziantep Medical Journal, 18(1), 31-36.
AMA	Wabe NT, Alemu M. Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia. Gaziantep Medical Journal. February 2012;18(1):31-36.
Chicago	Wabe, Nasir Tajure, and Mohammed Alemu. “Immunological and Clinical Progress of HIV-Infected Patients on Highly Active Antiretroviral Therapy in North West Ethiopia”. Gaziantep Medical Journal 18, no. 1 (February 2012): 31-36.
EndNote	Wabe NT, Alemu M (February 1, 2012) Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia. Gaziantep Medical Journal 18 1 31–36.
IEEE	N. T. Wabe and M. Alemu, “Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia”, Gaziantep Medical Journal, vol. 18, no. 1, pp. 31–36, 2012.
ISNAD	Wabe, Nasir Tajure - Alemu, Mohammed. “Immunological and Clinical Progress of HIV-Infected Patients on Highly Active Antiretroviral Therapy in North West Ethiopia”. Gaziantep Medical Journal 18/1 (February 2012), 31-36.
JAMA	Wabe NT, Alemu M. Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia. Gaziantep Medical Journal. 2012;18:31–36.
MLA	Wabe, Nasir Tajure and Mohammed Alemu. “Immunological and Clinical Progress of HIV-Infected Patients on Highly Active Antiretroviral Therapy in North West Ethiopia”. Gaziantep Medical Journal, vol. 18, no. 1, 2012, pp. 31-36.
Vancouver	Wabe NT, Alemu M. Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia. Gaziantep Medical Journal. 2012;18(1):31-6.

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