Improvement in immunological parameters in patients receiving highly active anti-retroviral therapy in Nepal.

Highly active anti-retroviral therapy (HAART) has been freely available in Nepal since 2004. In the present longitudinal study, we followed two distinct cohorts of human immunodeficiency virus-infected participants, those receiving HAART and those under assessment of eligibility for HAART, during the period 2005-2007 in Kathmandu, Nepal. The median change in CD4+ T-cell count among participants receiving HAART after 12 months of the initiation of therapy was +118 T cells/μl (95% confidence interval [CI], +91 to +145 T cells/μl) and that among participants under assessment of eligibility for HAART was -74 T cells/μl (95% CI, -103 to -44 cells/μl). However, the median CD8+ T-cell count after 12 months remained stable in both the cohorts (P > 0.05). The CD4+/CD8+ T-cell ratio increased from 0.16 to 0.26 after 12 months of therapy (P < 0.001). The multivariate regression model revealed that participants >30 years of age, and injection drug users had significantly lower increases in the CD4+ T-cell count in response to therapy. We observed a high proportion of loss to follow-up after 12 months of therapy; however, the associated factors were unknown. In conclusion, we observed a significant improvement in the CD4+ T-cell count in participants receiving HAART; however, the CD4+/CD8+ T-cell ratio remained <0.5 after 12 months of treatment.