Immunological outcomes after six months with first line antiretroviral therapy: a lesson from Yogyakarta, Indonesia

Abstract

Introduction: More than 1,300 children aged 0-14 years were infected with HIV in Indonesia by 2016. Adequate antiretroviral therapy (ART) can increase nutritional and immunological status, reduce incidence of opportunistic infection and mortality caused by HIV infection. After ART initiation, the children’s treatment response needs to be monitored with CD4⁺ cell count and Viral Load (VL) evaluation. In resource-limited setting, clinical and immunological parameters can be used to evaluate ART outcomes. The aimed of this study to know immunological status of the patient after 6 months ART in Dr. Sardjito Hospital in Yogyakarta, Indonesia.

Methodology: A retrospective study was conducted from January 2010 to May 2016. HIV-infected children aged 0-18 years who were given first-line ART at least 6 months were included in this study. Age when ART initiation, gender, residence, nutritional status, clinical staging based on WHO criteria, incidence of hospitalization, baseline CD4⁺ cell count and CD4⁺ cell count after 6 months of therapy, tuberculosis treatment, and ART regimens were collected from medical records. Data were entered and analyzed using SPSS version 20.0

Results: Thirty-five subjects were included in this study. Median CD4⁺ T cell percentage increased from 3.16 (IQR 1-18) % to 11.0 (IQR 2-32) %, whereas median CD4⁺ absolute cell count increased from 9.5 (IQR 3-176) cell/mm³ to 419.5 (IQR 202-1428) cell/mm³.

Conclusion: Immunologic conditions could improve even with very low levels of CD4⁺ T cell percentage and CD4⁺ absolute cell count. Monitoring immunologic conditions and adherence of children with ART are essential to improve treatment outcomes.