Sponsor
The ART-LINC of IeDEA Collaboration was funded by the United States National Institute of Health (NIH - Office of AIDS Research) together with the French Agence Nationale de Recherches sur le Sida et les hépatites virales (ANRS – grants 12101 and 12138).
Published In
BMC Infectious Diseases
Document Type
Article
Publication Date
6-2012
Subjects
Antiretroviral therapy, HIV infections -- Treatment -- Developing countries, Viremia, RNA -- Analysis
Physical Description
9 pages
Abstract
Background: Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART.
Method: Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, clinical stage and year of starting ART.
Results: 3,338 patients were included (14 cohorts, 64% female) and the group had the following characteristics: a median follow-up time of 1.6 years, a median age of 34 years, and a median CD4 cell count at ART initiation of 107 cells/μL. All patients with suppressed HIV-RNA at M12 had a continuous increase in CD4 cell count up to 18 months after treatment initiation. By contrast, any degree of HIV-RNA replication both at M6 and M12 was associated with a flat or a decreasing CD4 cell count slope. Multivariable analysis using HIV-RNA thresholds of 10,000 and 5,000 copies confirmed the significant effect of HIV-RNA on CD4 cell counts both at M6 and M12.
Conclusion: In routinely monitored patients on an NNRTI-based first-line ART, on-going low-level HIV-RNA replication was associated with a poor immune outcome in patients who had detectable levels of the virus after one year of ART.
Note: At the time of writing, David Bangsberg was affiliated with Immune Suppression Syndrome Clinic (ISS).
DOI
10.1186/1471-2334-12-147
Persistent Identifier
http://archives.pdx.edu/ds/psu/19064
Publisher
BioMed Central
Citation Details
Calmy A, Balestre E, Bonnet F, Boulle A, Sprinz EE, Wood R, Delaporte E, Messou E, McIntyre J, Marhoum El Filaili K, Schechter M, Kumarasamy N, Bangsberg D, McPhail P, Van Der Borght S, Zala C, Egger M, Thiébaut R, Dabis F. Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings. BMC Infect Dis. 2012 Jun 28;12(1):147
Description
©2012 Calmy et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.