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Correspondence should be addressed to Kwame Ohene Buabeng ; ku. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Ghana has since adopted this recommendation; however there is paucity of scientific data that reflects the safety and efficacy of the tenofovir-based therapy compared to zidovudine in the Ghanaian health system.
This study sought to assess the comparative immune reconstitution potential between tenofovir and zidovudine-based HAART regimens, which includes lamivudine and efavirenz in combination therapy. The study included 80 patients in the tenofovir cohort while 26 patients were on the zidovudine regimen. The occurrence of HIV comorbidities profile was assessed at diagnosis and throughout the study period. The baseline CD4 T cells count of the participants was also assessed at diagnosis and repeated at a median period of five months range 4—6 monthsafter commencing treatment with either tenofovir- or zidovudine-based HAART.
Studies suggest CD4 T cell death via cytolysis, chronic immune activation [ 3 — 5 ], cytotoxic T cells response, and gpenvelop induced immune reactions [ 6 — "Arv efter sambo" ] to partly account for the overall decline. Furthermore, the failure of thymus T cell hemostatic function due to HIV-induced thymopathy and infection of hematopoietic progenitor cells
Arv efter sambo to establish this progressive CD4 T cell decline in chronic HIV infection [ 36 ].
The rate of CD4 T cell
Arv efter sambo is believed to vary with different HAART combinations and is also affected by both human age, gender, baseline and CD4 and CD8 count and viral baseline viral load factors [ 3101115 — 17 ].
Both Spaulding et al. However, Joshi et al. Since the Arv efter sambo of tenofovir-based regimen in Ghana inthere has been little or no scientific data that reflect the local scientific reality as a developing country and must be addressed and put into perspective.
The above-mentioned HAART regimens are the commonly used and readily available first-line therapeutic options for the management of HIV 1 infections at KATH and in Ghana, with tenofovir regimen believed Arv efter sambo have a favorable dosing schedule and more tolerable effects than Arv efter sambo zidovudine regimen. The only difference between the two cohorts was either the use of tenofovir or zidovudine in the respective cohorts, with all other variables being constant.
Also the sampling technique used for selection of patients for participation in the study was systematic random sampling and thus did not interfere with the choice of treatment. A total of 80 participants were in the tenofovir cohort while 26 were in zidovudine cohort.
Included in the study were adults aged 18 years and above and newly diagnosed of Arv efter sambo 1 in Furthermore and more importantly, to be considered for the study, one must have Arv efter sambo on any two of the commonly prescribed regimens, namely, tenofovir with lamivudine and efavirenz tenofovir cohort or zidovudine with lamivudine and efavirenz. These were necessary to limit confounding factors and provide similar conditions for a plausible comparison.
Each patient who consented for inclusion in the study was given a unique identification number and allocated a designated location in the data collection notebook in an ordered fashion. STATA version 12 was used for data analysis.
The within-group variations of the paired differences between CD4 T cell count before and "Arv efter sambo" five months of treatment were compared using Wilcoxon Signed Ranks Test in each cohort and overall effect.
The Mann—Whitney test was used to test for differences in CD4 T cell absolute count change across the treatments cohorts and human factors. Approval was sought from the management of the Komfo Anokye Teaching Hospital.
This was to ensure that the hospital has prior knowledge of the research and to affirm if the facility is equipped enough to enable the proper execution of the research work. Finally, during recruitment of study subjects, a written informed consent was obtained from the study participants freely, after the purpose of the study has been explained to them, and they "Arv efter sambo" their immediate relations have been assured of client confidentiality and anonymity of data.
In this study, there were The participants were found to "Arv efter sambo" a mean age of. However, females were relatively younger with a mean age of compared to males with mean age of with both sexes showing considerable age variability. The most prevalent comorbidity was tuberculosis with 21 Out of participants recruited into the study, 17 were lost to follow-up while 89 were successfully followed up for a median period of five months 20th week.
Also, within each treatment group, there was significant increase in posttreatment CD4 T cells count from baseline after 5 months of treatment. The extent of CD4 count change between baseline and posttreatment was assessed between the two cohorts.
Furthermore, the univariate Mann—Whitney tests to determine the CD4 count change between those with and without individual comorbidities and young and older adults were unexpectedly found not to be significantly associated with any difference in CD4 count change after HAART as observed.
However in a multivariate analysis gender and likewise other variables were found not to be associated with CD4 T cell change. In terms of serious ADRE, one participant with Kaposi sarcoma in tenofovir cohort experienced tenofovir induced nephropathy and two experience intolerable psychosis. Moreover, out of the proportion of participants who reported side effects in each treatment arm, Many studies support the assertion that HAART enhances immune recovery which partly is reflected as an increase in absolute CD4 T cell count [ 311 ].
However this Arv efter sambo is believed to be affected by
Arv efter sambo type of HAART combination and other factors [ 3101421 ]. This study finding agrees with many studies that HAART enhances immune recovery [ 3101519 ]. The finding is consistent with a systematic review by Gallant et al. From other studies, "Arv efter sambo" ability of any HAART regimen to effect CD4 cell repopulation is premised on enhancing thymic functionality for improve thymopoiesis [ 31525 Arv efter sambo. The observed immune recovery in this study may be due to reduction in chronic immune activation, cytolysis, cytotoxic viral proteins, and an increase in thymic function though there is not much data on these parameters for analysis to support this claim [ 271526 ].
However the observed higher CD4 T cells absolute count increase in the tenofovir cohort compared to zidovudine cohort may be attributable to the postulated zidovudine induced stasis of CD4 T cells expansion. Zidovudine seems to enhance cytotoxic lymphocytes activity leading to infected CD4 T cells death via cytolysis. It also impedes antigen and lectin-induced T cells proliferation and mitosis causing an impaired T cells expansion [ 17 ].
In a univariate analysis, gender was associated with CD4 count change as females recorded a significantly elevated median CD4 count 7— compared to males However in a multivariate analysis, the association not statistically significant. This was unexpected as it finds no association between any of the variables evaluated.
With regard to age, children and younger adults generally have lager thymic volume reserve at baseline than the elderly and are expected to have superior immune recovery [ 1527 ]. However this study excluded children and adolescence but only considered young and old adults. Also, more than half of the study participants were in stage III and are normally known to have reduced baseline thymic reserve due to long standing HIV infection [ 15 ].
These could account for the fact that there is no significant difference in immune reconstitution between the older and young adults and even across sex. The Lartey et al. Altogether, ADREs were reported in about Arv efter sambo third of the study participants. Those in the tenofovir cohort somehow appeared to have experienced more of the ADRs and multiple adverse events compared to the zidovudine cohort. The unexpected higher incidence of ADREs associated with tenofovir compared to zidovudine can be explained as follows.
This also reveals a possible potentiated interaction of tenofovir and efavirenz resulting in synergized CNS adverse effects of the tenofovir regimen. One patient in the tenofovir also reported serious psychiatric disorders resulting in subsequent change to nevirapine. Gender related difference in side effects exists with females estimated to possess higher likelihood of experiencing adverse events to HAART some found no or contradicting results [ 1423 ].
There was no significant difference between males and females in this study; however, females appeared to experience more
Arv efter sambo ADRs than males. In all, the unexpected higher ADREs associated with tenofovir compared to zidovudine may be due population variation and synergistic ADREs cutaneous and neuropsychiatric effects associated with tenofovir and efavirenz.
Also the higher number of participants in the tenofovir cohort and female gender compared to the zidovudine and male gender, respectively, may have also influenced the proportions of ADREs as observed [ 1528 — 303235 ].
Despite the evidence generated in this study, data on the HIV RNA load, a primary biomarker, could not be obtained for all of the study patients during the follow-up phase in the study, due to breakdown of Cobas Ampliprep HIV 1 analyzer at the facility. If this were done the evidence generated in this study could have been more robust.
This study could not also obtain follow-up data for LFT, FBC, and RFT on about two-thirds of the study participants due to financial constraints and hence results on these parameters could not be assessed for more definitive evaluation of safety of the HAART pharmacotherapy.
Finally about 17 patients were lost to follow-up and thus could not be traced for assessment. This was believed to be the result of movement of the patients or their relations out of catchment area of the hospital or might have travelled to live in other locations outside Arv efter sambo catchment area of the hospital.
We therefore recommend a study with a much more robust design such as a multicenter noninferiority trial or a national cohort study to compare the efficacy and safety of tenofovir-based HARRT regimens and zidovudine-based HAART regimens in Ghana. The tenofovir-based
Arv efter sambo had a superior immune reconstitution potential compared to zidovudine-based cohort.
Patients on the zidovudine regimen also improved significantly with regard to CD4 T cell repopulation. Patients on the tenofovir-based regimen and females reported to have had more ADREs compared to those on zidovudine-based regimen. Although the tenofovir treatment arm in this study showed a superior immunological recovery, its use must be closely monitored to address the occurrence of ADREs to improve compliance.
The authors acknowledge the staff of chest clinic and serology and virology laboratory units of Komfo Anokye Teaching Hospital for their cooperation and support during this research work. To lecturers and colleagues of the Department of Pharmacology, KNUST, the authors really appreciate your intellectual contribution that has aided the compilation of this manuscript.
International Journal of Chronic Subscribe to Table of Contents Alerts. Table of Contents Alerts. Inclusion and Exclusion Arv efter sambo Included in the study were adults aged 18 years and above and newly diagnosed of HIV 1 in Data Collection Each patient who consented for inclusion in the study was given a unique identification number and allocated a designated location in the data collection notebook in an ordered fashion.
Demographic and baseline characteristics of the study participants at diagnosis. World Health Organization W. Apoptosis pathways in HIVinfected patients before and after highly active antiretroviral therapy: View at Google Scholar M.
A continuum or distinct underlying mechanisms?
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