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2 results on '"HIV-RNA threshold"'

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

Author

Calmy, Alexandra, Balestre, Eric, Bonnet, Fabrice, Boulle, Andrew, Sprinz, Eduardo, Wood, Robin, Delaporte, Eric, Messou, Eugène, McIntyre, James, El Filali, Kamal Marhoum, Schechter, Mauro, Kumarasamy, N, Bangsberg, David, McPhail, Patrick, Der Borght, Stefaan Van, Zala, Carlos, Egger, Matthias, Thiébaut, Rodolphe, and Dabis, François

Subjects
*CD4 antigen, *ANTIRETROVIRAL agents, *VIREMIA, *IMMUNE response, *SUPPRESSOR cells
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. [ABSTRACT FROM AUTHOR]

Published
2012
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2. Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings

Author

Alexandra, Calmy, Eric, Balestre, Fabrice, Bonnet, Andrew, Boulle, Eduardo, Sprinz, Robin, Wood, Eric, Delaporte, Eugène, Messou, James, McIntyre, Kamal Marhoum, El Filali, Mauro, Schechter, N, Kumarasamy, David, Bangsberg, Patrick, McPhail, Stefaan, Van Der Borght, Carlos, Zala, Matthias, Egger, Rodolphe, Thiébaut, François, Dabis, HIV Unit, Geneva University Hospital, Epidémiologie et Biostatistique [Bordeaux], Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Université Bordeaux Segalen - Bordeaux 2, Service de Médecine Interne et Maladies Infectieuses, CHU Bordeaux [Bordeaux], School of Public Health and Family Medicine, University of Cape Town, South Brazil HIV Cohort, Hospital de Clínicas de Porto Alegre, Gugulethu ART Programme, Institut de Recherche pour le Développement (IRD), Centre de Prise en Charge, de Recherche et de Formation sur le VIH/SIDA, CePReF, Perinatal HIV Research Unit, Operational Research on ART (OPERA), Service des Maladies Infectieuses, Hôpital Ibn Rochd, Rio HIV Cohort, YRG Centre for AIDS Research and Education, Immune Suppression Syndrome Clinic (ISS), Helen Joseph Hospital Themba Lethu Clinic, Heineken International Health Affairs, Prospective Evaluation in the Use and Monitoring of Antiretrovirals in Argentina, PUMA, Institute of Social and Preventive Medicine (ISPM), University of Bern, 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). The IeDEA network is now funded through collaborative agreements by the National Cancer Institute (NCI), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Allergy And Infectious Diseases (NIAID)., for the ART-LINC of IeDEA Collaboration (Asia, South America, East, Southern and West Africa), Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), BMC, Ed., Department of Public Health and Family Medicine, and Faculty of Health Sciences

Subjects
Male, CD4 slope, HIV Infections, 030312 virology, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, 030212 general & internal medicine, Cd4 cell count, Stage (cooking), ddc:616, 0303 health sciences, Terapia anti-retroviral de alta atividade, 3. Good health, HIV Infections/drug therapy/immunology, RNA, Viral/genetics, Infectious Diseases, HIV-RNA threshold, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, RNA, Viral, Female, low or moderate-level viremia, Research Article, Adult, Resource limited settings, medicine.medical_specialty, Anti-HIV Agents, CD4 cell counts, Viremia, CD4 count, Anti-retrovirais, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Internal medicine, Humans, lcsh:RC109-216, In patient, business.industry, medicine.disease, Antiretroviral therapy, Contagem de linfócito CD4, CD4 Lymphocyte Count, Regimen, Institutional repository, Antiretroviral treatment (ART), Anti-HIV Agents/therapeutic use, Immunology, HIV-1, business, Limited resources
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.

Published
2012
Full Text
View/download PDF

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