Abstract:
Abstract
Background: HIV attacks an immune cell called the CD4 cell. HIV and TB have been closely
linked since the emergence of AIDS and TB is the most common infectious disease affecting HIV
positive. East and Southern Africa is the hardest region hit by the HIV, this region is the home to
6.2% of the world’s population but it has 19.4 million people living with the virus. The main
objective of this study was modeling the determinants of TB status and CD4 cell count among
HIV/AIDS patients from HAART in FHTSH.
Methods: Longitudinal data was obtained from a sample of 226 HIV/AIDS patients at FelegeHiwot
Teaching and Specialized Hospital in north-west, Ethiopia. Two methods of modeling
approaches were used those were separate and joint modeling. In the joint model, a LMM and
GLMM sub-models were employed together for square root of CD4 cell and TB status
respectively.
Results: Based on the separate model, the joint models were built to know the correlation
between mean change of and CD4 count and TB status overtime. Finally, appropriate model was
selected based on AIC and BIC values. The fit statistics showed that, for patient’s age increased
by one year, the mean square root of CD4 cell count was decreased by 0.025
cell/mm,
3
controlling other variables constant. The average square root of CD4 cell count for
patients whose functional status were ambulatory and bedridden was lower by 3.915
cell/mm
3
and 4.617 cell/mm
3
compared to those who can perform their day to day activity which
is working status respectively. The estimated odds of patients being co-infection HIV/TB for who
lived in rural area were 3.7 times the estimated odds of those who lived in urban area. The
evolution of the association at initial ( ) for the square root of CD4 cell count and TB status
was which was essentially the correlation between the two random intercepts. The
correlation between the two responses overtime was -0.148. Patients WHO stages, functional
status, weight and hemoglobin were significant predictors for both responses.
Conclusion: Having lower weight, late WHO clinical stages, non-adhered, opportunity infection
disease, lower hemoglobin, being ambulatory and bedridden were associated with higher risk of
HIV/TB co-infection and the reduction of CD4 cell count. Therefor there should be a special
attention and intervention for HIV positive patients.
Keywords: CD4 cell, TB status, Separate Model, Joint Model, HAART