Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings

• Autor(a) principal: Calmy, Alexandra
• Data de Publicação: 2012
• Outros Autores: Balestre, Eric, Bonnet, Fabrice, Boulle, Andrew, Sprinz, Eduardo, Wood, Robin, Delaporte, Eric, Messou, Eugène, McIntyre, James, El Filaili, Kamal Marhoum, Schechter, Mauro, Kumarasamy, Nagalingeswaran, Bangsberg, David R., Macphail, Patrick, Borght, Stefaan Van Der, Zala, Carlos, Egger, Matthias, Thiébaut, Rodolphe, Dabis, François
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFRGS
• Texto Completo: http://hdl.handle.net/10183/111604
• topic: HIV-1; Contagem de linfócito CD4; Terapia antirretroviral de alta atividade; Antirretrovirais; HIV-1; CD4 count; CD4 slope; HIV-RNA threshold; Resource limited settings

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.