Evolution of the Immune Status in Children Infecte

Journal of Environmental Science and Engineering A 3 (2014) 219-223

Formerly part of Journal of Environmental Science and Engineering, ISSN 1934-8932

DDAVID PUBLISHING

Evolution of the Immune Status in Children Infected with

HIV/AIDS on Antiretroviral Treatment in Lubumbashi,

Democratic Republic of Congo

Mbayo Lukasu1, Kazadi Mwadianvita2, Kalumba Kambote1, Kasamba Ilunga2, Kabongo Katabwa1, Ntambue

Mukengeshayi3 and Wembonyama Okitosholo1

1. Center of Excellence in Care of HIV/AIDS, University of Lubumbashi, Lubumbashi 1885, Democratic Republic of Congo

2. Department of Laboratory, University of Lubumbashi, Lubumbashi 1885, Democratic Republic of Congo

3. School of Public Health, University of Lubumbashi, Lubumbashi 1885, Democratic Republic of Congo

Abstract: The objective was to describe the immunological status among children infected with HIV (human immunodeficiency

virus) at baseline and their change during the treatment. This longitudinal study conducted at the Center of Excellence in Lubumbashi

from 2nd semester, 2011 to the 2nd semester, 2012, examined the records of children who had been receiving antiretroviral therapy

for 48 weeks. A count of CD4 + T lymphocytes was performed at the beginning, 24 weeks, and 48 weeks of treatment. The

immunological status was defined by the 1996 CDC (centers for disease control) immunological categories. All the children were on

zidovudine, lamivudine/nevirapine or Efavirens. At initiation of treatment, severe immunosuppression was found in 56%, moderative

in 28% and lacked in 16% of cases. Furthermore, after 48 weeks of treatment, a change in the immunological status was observed in

42% of cases. In contrast, 58% of cases kept in their original status. In this cohort, the immune status has not undergone significant

change.

All Rights words: HIV infection, antiretroviral therapy, immunological status, Lubumbashi.

1. Introduction

Pediatric HIV/AIDS (human immunodeficiency

virus/acquired immunodeficiency syndrom) is a

public health problem worldwide and in the DRC

(Democratic Republic of Congo) in particular. The

WHO (World Health Organization) estimated that

3.4 million children live with HIV worldwide, with

pregnant woman [3]. Effective ART leads to a gradual

and slower an increase of CD4 + T lymphocytes in

patients whose way of advanced immunosuppression

has evolved extended [4]. The objective was to

describe the immunological status among children

infected with HIV at baseline and their changes during

48 weeks of antiretroviral therapy.

over 90% in sub-Saharan Africa [1]. In the DRC,

2. Material and Methods

the National Programme for Fighting against

2.1 Framework and Type of Study

HIV/AIDS estimated the number of children under 15

The study was conducted at the CE (Center of

infected with HIV at 110,000 including about 38,950

Excellence) of the University of Lubumbashi

eligible, only 5,315 benefit from ART (antiretroviral

integrated with Jason Sendwe Hospital which is the

therapy) [2]. In Lubumbashi, the seroprevalence of

largest public hospital in Lubumbashi. This structure

HIV infection was estimated at 7% and that of the

children at 3.7% as it is correlated to that of the

provides medical consultations and takes care freely in

charge of persons living with HIV (PLHIV) without

Corresponding author: Mbayo Lukasu, junior, clinical

officer, research field: HIV clinic. E-mail:

exclusivity age and sex.

********************;***********************.

220Evolution of the Immune Status in Children Infected with HIV/AIDS on Antiretroviral Treatment in

Lubumbashi, Democratic Republic of Congo

This is a longitudinal study of the records of

children receiving ART conducted during the period

from 2nd semester, 2011 to 2nd semester, 2012. That

is to say 48 weeks (W48).

2.4 Statistical Analysis

The collected data were entered and analyzed using

Epi Info 3.5.1 software. The usual descriptive

statistics were expressed as mean for quantitative

variables and the proportions for categorical variables.

2.2 Study Population

The Excel 2010 spreadsheet has helped the authors to

The study population has consisted of 36

make the graphics. Patient characteristics at initiation

HIV-infected children aged 2-15 years, whose

of antiretroviral treatment were compared using the

HIV status have been tested and confirmed by

strategies and national algorithm [5] and have been

put on treatment according to clinical and

immunological criteria in application in DRC [2].

The children who had been included in this study

are children registered in the 2nd half of 2011,

which have started ART at the Center of Excellence,

followed for 48 weeks of treatment and made at

least one CD4 + T lymphocytes after initiation

treatment.

2.3 Data Collection

The collection was carried out through a grid that

incorporated the following parameters to be studied:

sociodemographic (age and sex); clinics (diseases and

OIs (opportunistic infections) diagnosed at the

beginning and during follow-up were classified

according to clinical stages I, II, III and IV of the

WHO [6]). Biologically, (the typing of CD4 + T

lymphocytes was analyzed using a BD Facs count

(Becton Dickinson) at the beginning, 24 weeks and 48

weeks of ART. Immunological status was defined by

immunological categories of CDC (centers for disease

control) in 1994, and was ranked category 3, 2 and 1,

respectively in severe immunosuppression (< 15%),

moderative immunosuppression (15% to 24%), and

lack of immunosuppression (≥ 25%) [7]. All children

had received the same triple generic therapy:

nevirapine 120 mg·m-2 twice daily; zidovidune 180

mg·m-2 twice daily; lamividune 4 mg·m-2 twice daily

with the possibility of alternative molecules. Any

children had benefited from the viral load before and

during ART.

chi-square test X2.

3. Results

3.1 General Characteristics of HIV-Infected Children

Forty-five HIV-infected children before ART were

examined and 36 were selected who responded to the

criteria of selection. The average age was 8 ± 3.5

years (2-15 years) and the sex ratio was 1. On the 36

remaining HIV-infected children, follow-up data were

immunologically available at initiation, at 24 weeks

and at 48 weeks of ART.

3.2 Evaluation of Clinical and Immunological

Parameters before the ART

The mean of CD4 + T lymphocytes average were

20%, 16% and 14%, respectively in different

categories of immunosuppression 3, 2, and 1 of

immunological classification of CDC 1994. The

immunological status in HIV-infected children were

56%, 28% and 16%, respectively in the category of

immunosuppression 3, 2, and 1 of immunological

staging of CDC 1994. The opportunistic infections

which were the most observed were thrush (7%),

pneumocystosis (5%), tuberculosis (3%), and the

protein calorie malnutrition (19%).

3.3 Evaluation on ART

Clinically, a case of tuberculosis was observed on

36 HIV-infected children. Immunologically, on 36

observations of the mean of CD4 + T lymphocytes, it

was observed an upward immunological profile of

average rates mean of CD4 + T lymphocytes to 20%,

24%, and 26%, respectively, which was an increase of

All Rights Reserved.

Evolution of the Immune Status in Children Infected with HIV/AIDS on Antiretroviral Treatment in

Lubumbashi, Democratic Republic of Congo

2214% and 6% compared to baseline in the category 1. In

category 2, it was observed 16%, 20%, and 22%,

respectively, which was an increase of 4% and 6%. In

category 3, it was noted a downward immunological

profile of average rates mean of CD4 + T lymphocytes

to 20%, 16% and 12%, respectively, which was a

decrease of 2% and 8%. There are not statistically

significant differences in different immunological

categories of CDC 1994 (Fig. 1).

These increases of CD4 + T lymphocytes had led to

changes in the immunological status in different

immunological status CDC 1994 after 48 weeks of

treatment in 42% of cases while 58% of cases had

kept their original status despite the increase or the

decrease (Fig. 2).

4. Discussion

In DRC, the management of patients infected with

HIV is coordinated by the National Programm for

Fighting against Sexually Transmited Infections and

HIV/AIDS. Since 2005, under the initiative was to put

three million people on antiretroviral by the end of

2005 (3 by 5), ART is issued free of charge to patients.

The observations made in this study are compared

All Rights of following (weeks)

Mean

of

CD4

+

T

(%)

Fig. 1 Evolution of the immunological profile in different categories under antiretroviral treatment during 48 weeks.

SI: severe immunosuppression; MI: moderative immunosuppression; LI: lacked immunosuppresion.

Period of following (weeks)

Fig. 2 Distributions of patients according to the immune status at baseline and during treatment.

SI: severe immunosuppresion; MI: moderative immunosuppresion; LI: lacked immunosuppresion.

Immunological

status

(%)

222Evolution of the Immune Status in Children Infected with HIV/AIDS on Antiretroviral Treatment in

Lubumbashi, Democratic Republic of Congo

with literature data. The average age of the children

was 8 ± 3.5 years. Other researchers such as Brigita

and Seth [8], and Djadou and Agbèrè [9] in Togo had

found that the average age is 6 years, 3 months and

7.7 years. Kumarasamy and Solomon [10] in the south

of India noted in their series: oral candidiasis is 29%,

tuberculosis is 13.4%. In this cohort, it is observed

that oral candidiasis is 7%, tuberculosis is 3%,

pneumocystosis is 5% of protein and calorie

malnutrition is 19% at the inclusion. In the course of

treatment, 36 children are observed on case of

tuberculosis (3%). The immunological response

allowed recovery of immunological status CDC 1994.

But these differences were not significant due to small

sample size. Moreover, Song and Shaffiq [11] had

noted high virological and immunological

discrepancies despite a very significant increase of

CD4 + T lymphocytes in their series. The immune

status has changed in 42% of cases overall. This

suggests that the improvements of CD4 + T

lymphocytes occurred regardless of their

immunological status. In this context, it is important

to enjoin Djadou and Agbèrè [9] in Togo who had

advocated improving compliance by the social

workers and the psychological care of children

refusing to take medications to their parents

explaining the importance of adherence during home

visits. The other 58% of cases had kept their original

status despite the increase or the decrease of CD4 + T

lymphocytes. These results suggest that further

investigation with a larger sample would add one

more to the study by explaining the relationship

between the initial factors for initiation of ART and

therapeutic response in midst. The prescribed ART in

this study complies with WHO 2009 and consists of

zidovudine, lamivudine/nevirapine or efavirens, which

are very generic combination prescribe in the country

and limited resource such as DRC, because it is lower

cost, availability, and proven effectiveness. Limit: the

size of this sample and the follow-up period are

relatively short and limited the statistical power.

However, a prospective study with a larger sample is

needed in Lubumbashi.

5. Conclusions

The results reveal a change in the immunological

status of CDC 1994 in 42% of cases in overall induce

by an increase of CD4 + T lymphocytes under

antiretroviral therapy. The authors emphasize the

typing of CD4 + T lymphocytes in the initiation,

monitoring and qualification of immunological status

on antiretroviral treatment. In conclusion, the results

of this study suggest that further investigation with a

larger sample would add one more to the study by

explaining the relationship between the initial factors

for initiation ART and therapeutic response in

Lubumbashi.

Acknowledgments

The authors express their sincere thanks to the staff

of the Centre of Excellence in HIV/AIDS and the

Clinical Laboratory of the University of Lubumbashi

for their technical support and collaboration.

References

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[2] NPF HIV/AIDS (National Program for the Fight against

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Lubumbashi, Democratic Republic of Congo

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