A research report submitted to the faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine
(Pharmacotherapy) / Background: The decision of when to start treatment in an HIV-infected individual has always been
problematic as far as CD4 count is concerned.
Aims: To determine the clinical outcome of patients who commence HAART at different CD4 cell
count levels.
Method: Retrospective analysis of records of a cohort of patients who are received ART at workplace
wellness clinics in three mines in Limpopo province from January 2003 to December 2009. Patients
were divided into three groups based on their baseline, group A (CD4 <100), group B (CD4 101-200)
and group C (CD4 201-250)
Each patient’s data was analyzed one year after his/her commencement.
Results: The percentage of patients who died in group A (16%) differs significantly from the
percentage of patients who died in group B (4%) (Fisher exact test p= 0.038) and also differ
significantly from the percentage of patients who died in group C (0%) (Fisher exact test p= 0.011).
The percentages of patients who developed TB in the three groups are 8%, 8% and 2.9% respectively.
When compared statistically, these percentages do not differ significantly (Fisher exact test
p=0.059).The percentages of patients with severe bacterial pneumonia in the three groups (2%, 2% and
0% respectively) do not differ significantly (Fisher exact test p=0,276).The percentage of hospital
admissions for patients in group A (18%) differ significantly from the percentage in group B (6%) and
the percentage in group C (6%) (Fisher exact test p= 0.05). The percentage of patients with weight loss
of more than 10% of baseline value in group A (24%) differ significantly from the percentage in group
B (4%) (Fisher exact test p= 0.003) and also differ significantly to from the percentage in group C (0%)
(Fisher exact test p= 0.001). The percentage of patients with undetectable viral load in group B (89%)
is significantly different from the percentage in group A (69%) (Fisher exact test p= 0.03) and is also
significantly different from the percentage in group C (61%) (Fisher exact test p= 0.008).The change in
mean CD4 cell count was found to be statistically significant within each group (paired t test,
p<0.0001), but the mean changes between the three groups (132,141 and 172) respectively, do not
differ significantly (ANOVA test).
Conclusion: Patients with baseline CD4 cell count of less than 100 have a poor clinical outcome when
compared to patients with baseline CD4 cell count of more than 100. Efforts must be made to identify
patients early before CD4 cell count fall to below 100 and preferably initiate HAART when CD4 cell
count is above 200.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/13621 |
| Date | January 2011 |
| Creators | Mothapo, Khutjo Peter |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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