Variable Influencing Parameters of Different Levels of Immunosuppression in HAART-naive HIV Subjects in Nigeria

Background and Objectives: Varying degrees of immunosuppression may be observed in human immunodeficiency virus (HIV) infected subjects. This study sought to evaluate the factors which might influence different levels of immunosuppression in this group of subjects.

Methodology: Immunosuppression, defined as CD4<500 cells/ml, was evaluated in treatment-naïve HIV subjects. Body mass index (BMI), 24 h urine creatinine (24HUCr), 24 h urine protein (24HUP), creatinine clearance (ClCr), hemoglobin (Hb) and CD4 cells count were determined and the data compared among the subjects who have different levels of immunosuppression, defined here as mild for CD4 350-499 cells/ml, moderate for CD4 200-349 cells/ml and severe for CD4<200 cells/ml.

Results: CD4 cells count 200-349/ml was prevalent in 31.3%, CD4 350-499/ml in 25.4% and CD4 ≥ 500 cells/ml in 122(31.0%) of the HIV subjects. Immunosuppression was significantly associated with BMI (df=9, p=0.008), 24HUCr (df=6, p=0.019) and anemia (df=9, p<0.001). None of these three variables, in addition to 24HUP, was a predictor of moderate immunosuppression (CD4 cells count 200-349/ml). However, BMI, ClCr, 24HUP and Hb were predictors of mild immunosuppression (CD4 350-499 cells/ml) (p=0.006, p=0.008, p=0.026 and p=0.003 respectively).

Conclusion: Variable levels of immunosuppression were prevalent in this study. Anemia, abnormal weight and renal damage were common but variable in subjects who have different levels of immunosuppression in the early stage of HIV infection.