The Effectiveness Of First Line Antiretroviral Therapy And The Impact Of Micronutrient Levels On Patients’ Response To Treatment In Windhoek, Namibia

ABSTRACT

Nutritional levels can have profound impact on individuals living with HIV/AIDS and potentially hinder the effectiveness of antiretroviral therapy (ART). But sufficient data is lacking to establish a strong relationship especially in Namibia. In this study, the relationship between CD4 counts, viral load (VL), prescribed first line antiretroviral combinations, micronutrient levels and age was explored. Data spanning from 2006 to 2015 were retrospectively collected from Katutura State Hospital, Windhoek Central Hospital and Katutura Health Centre as well as prospective data on micronutrients. Polymerase chain reaction was used for VL testing, immunoassay for micronutrient analysis and immunophenotyping for CD4 count testing.

ANOVA, Pearson‟s correlation with cross tabulation determined the relationship between HIV 1 VL, CD4 count, micronutrients, the prescribed combinations and the age of patients. Medical records of 404 HIV positive adults and adolescents (13 15 years) and children (1 12 years) under ART took part in this study. In addition correlation between micronutrients levels, VL, CD4 count, at 36 months of treatment was investigated in 30 participants aged 13 55 years. HIV-infected individuals with at least 7 records on VL and CD4 count since initiation of treatment qualified for this study.

AZT/3TC/EFV combination was the best treatment across the study population with 83.3% VL decrease in ART naïve adults and adolescents. At the same time, the use of AZT/3TC/EFV and D4T/3TC/LPV r combinations in children decrease the VL by 50%. Correlation coefficient (r) between the first line treatment combinations and

iii

the age of patients in children population was observed (r = 0.38, P = 0.00) however, no significant correlation was observed for adult participants (adults and adolescents) and ARV drugs (r = 0.09, P = 0.11). A significant correlation between VL and CD4 count in adults and adolescents was observed at initial time (r = 0.24, P = 0.00), 6 months (-- r = 0.17, P = 0.00) and at 18 months (r = 0.19, P = 0.00). In the children population, an inverse correlation between VL and CD4 count was observed throughout 36 months of treatment but was only significant at 18 months (r = 0.03, P = 0.00), 30 months (-- r = 0.39, P = 0.00) and 36 months (r = 0.24, P = 0.04) respectively.

Among the 30 participants that took part in micronutrient analysis, normal, low, and high levels of magnesium, iron, folate and vitamin B 12 were observed with no significant correlation to CD4 count and VL. Furthermore, a significant negative correlation was found between ARV combinations and serum folate (-- r = 0.4, P = 0.03). Micronutrient levels had no role in the treatment failure observed within the population of adults and adolescents in this study. In adults and adolescents, only the combination of AZT/3TC/EFV and D4T/3TC/LPV-r could achieve viral suppression (VL< 1000 copies/mL) at 36 months of treatment and the combination of D4T/3TC/LPV-r was found to be more effective in patients with low VL before ART usage. Treatment failure observed in this study population happened as a result of some combinations losing their potency over the treatment period. The study also showed a greater need in concentrating on the age of patient especially in children younger than 12 years when prescribing anti HIV drugs hence a positive correlation between age and ARV drug combination was found in children.