Document Type : Original Article- English
Authors
1
USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
2
Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
3
Assistant Professor, Department of Biology, Faculty of Basic Sciences, Lorestan University, Khorramabad, Iran.
4
Assistant Professor, Department of Nutrition Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
5
Assistant Professor of Tropical and Infectious Diseases, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
Abstract
Introduction: The gradual decline in T-CD4+ cell counts following HIV infection leads to impaired immune function and serves as a primary determinant of the clinical course in HIV-infected patients. Antiretroviral therapy increases CD4+ lymphocyte levels, thereby enhancing immunity and reducing opportunistic infections and mortality. This study aimed to investigate the effect of three-drug antiretroviral regimens on CD4+ cell counts in HIV-infected patients in Khorramabad city.
Materials and Methods: In this observational cohort study, data from 242 HIV-infected patients receiving either NNRTI-based (n=181) or INSTI-based (n=61) regimens were analyzed. CD4+ cell counts were measured at baseline and at 6 months, 1, 2, 3, and 4 years post-treatment initiation. Generalized Estimating Equations (GEE) models were used to evaluate longitudinal changes in absolute CD4+ counts, and an independent t-test was performed to compare the mean change from baseline between groups.
Results: The INSTI-based group had a significantly lower baseline CD4+ count compared to the NNRTI-based group (331 vs. 452 cells/μL). The mean increase in CD4+ count from baseline was significantly greater in the INSTI-based group (406 cells/μL) compared to the NNRTI-based group (299 cells/μL) (P=0.002). However, GEE analysis demonstrated that patients on the NNRTI-based regimen maintained significantly higher absolute CD4+ counts throughout follow-up compared to the INSTI-based regimen (P<0.001), which likely reflects their higher baseline values.
Conclusion: Both regimens were associated with improvements in CD4+ cell counts. The INSTI-based regimen showed a greater mean increase from baseline, while the NNRTI-based regimen maintained higher absolute CD4+ levels over time. Due to the observational design, substantial baseline imbalances between groups, and small sample size in the INSTI group during long-term follow-up, no causal claims of superiority can be made for either regimen. These hypothesis-generating findings require confirmation through randomized controlled trials with balanced baseline characteristics.
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