Factors Associated with a Low CD4 Count among HIV-1 Infected Patients at Enrolment into HAART in Jos, Nigeria

Aim: To determine the factors associated with a low CD4 count among HIV-1 positive patients.
Study Design: Cross-sectional study.
Place and Duration of Study: Adult HIV clinic at the Jos University Teaching Hospital, Jos, between October 2010 and April 2011.
Methodology: Data on demographic, clinical and laboratory variables for 218 HIV-1 infected patients aged 20 years and older were analysed. A low CD4 cell count was defined as CD4 cell count <200 cells/ml based on the WHO criteria for severe immune suppression. A multivariate logistic regression modeling was fitted to determine the variables that were independently associated with a low CD4 count.
Results: Of the 218 HIV-1 infected patients, 119 (54.6%) had a low CD4 count at enrolment. The odds of having a low CD4 count was: 7 times higher in patients with WHO clinical stage 3 or 4 compared to those with stage 1 or 2 (P<.001) and 4 times higher in those with HIV RNA viral load ≥4.6 log10 copies/ml compared to those with less (P<.001); but the odds of having a low CD4 count was reduced by 63% in those patients that were resident in Plateau State compared to those resident outside the state (P=.01).
Conclusion: Our study patients were more likely to have a CD4 count <200 cells/ml which would suggest late presentation/ late HIV diagnosis and thus a delayed opportunity for timely access to HIV care and initiation of antiretroviral therapy. There is the need to intensify efforts in early routine HIV counseling and testing not only in health facilities in the cities but also in smaller towns and rural communities, so as to reduce the frequency of late HIV diagnosis with its potential implications.