Impact of Viral Load Suppression on CD4+ T-cell count and BMI following combine Antiretroviral Therapy (cART): preliminary findings in a resource poor setting

Immunological CD4+ T cell gain is representative of an effective response to combined antiretroviral therapy (cART) in HIV-infected persons. Nevertheless, baseline clinical and socio-demographic factors are significant moderators of this response. This study investigates the impact of viral suppression on immune reconstitution and body mass index (BMI) following ART initiation in Zaria, a resource-poor subpopulation in Northwestern Nigeria. A hospital-based prospective study was conducted among 44 cART-naïve HIV-positive individuals. BMI, CD4 counts and viral load were measured using standard methods at baseline and six months after initiation of cART. There was no significant difference in the CD4+ T-cell count at baseline and 6 months on cART along the different categories (C: < 200 cells/mm3, B: 200-499 cell/mm3, A: >500 cell/mm3). However, ~90% of subjects in category C had immunological failure 6 months on cART. The number of subjects with viral copies < 1000/ml at baseline was 7(16%), while at 6 months on cART the number increased to 35(80%), P<0.05. Viral suppression (VL copies <1000/ml) was significantly correlated with immune recovery (CD4 count > 200 cell/mm3) in obese individuals (P<0.02). There was a significant association between subjects with CD4+ count < 200 cells/mm3 after 6 months on ART and having a baseline VL copies of <1000/ml and low BMI (aOR 2.2 and 2.4 respectively, p≤0.05). Findings from this study suggest a high prevalence of paradoxical VL suppression but not immune CD4 gain in the studied subjects following cART. Larger studies are needed to corroborate these findings.