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

Identifieur interne : 000714 ( Main/Exploration ); précédent : 000713; suivant : 000715

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

Auteurs : Alexandra Calmy [Suisse] ; Eric Balestre [France] ; Fabrice Bonnet [France] ; Andrew Boulle [Afrique du Sud] ; Eduardo Sprinz [Brésil] ; Robin Wood [Afrique du Sud] ; Eric Delaporte [France] ; Eugène Messou [Côte d'Ivoire] ; James Mcintyre [Afrique du Sud] ; Kamal El Filali [Maroc] ; Mauro Schechter [Brésil] ; N. Kumarasamy [Inde] ; David Bangsberg [Ouganda] ; Patrick Mcphail [Afrique du Sud] ; Stefaan Van Der Borght [Pays-Bas] ; Carlos Zala [Argentine] ; Matthias Egger [Suisse] ; Rodolphe Thiébaut [France] ; François Dabis [France]

Source :

RBID : Hal:inserm-00788673

Mots-clés :

Abstract

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: Naive 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/uL. 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.


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Le document en format XML

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<orgName>Université Bordeaux Segalen - Bordeaux 2</orgName>
<desc>
<address>
<addrLine>146 rue Léo Saignat - 33076 Bordeaux cedex</addrLine>
<country key="FR"></country>
</address>
<ref type="url">http://www.univ-bordeauxsegalen.fr/</ref>
</desc>
</org>
</tutelle>
</tutelles>
</hal:affiliation>
<country>France</country>
</affiliation>
</author>
</analytic>
<series>
<title level="j">BMC Infectious Diseases</title>
<idno type="ISSN">1471-2334</idno>
<imprint>
<date type="datePub">2012-06-28</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc>
<textClass>
<keywords scheme="mix" xml:lang="en">
<term>CD4 count</term>
<term>CD4 slope</term>
<term>HIV-1</term>
<term>HIV-RNA threshold</term>
<term>Resource limited settings</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">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: Naive 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/uL. 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.</div>
</front>
</TEI>
<affiliations>
<list>
<country>
<li>Afrique du Sud</li>
<li>Argentine</li>
<li>Brésil</li>
<li>Côte d'Ivoire</li>
<li>France</li>
<li>Inde</li>
<li>Maroc</li>
<li>Ouganda</li>
<li>Pays-Bas</li>
<li>Suisse</li>
</country>
<region>
<li>Canton de Berne</li>
</region>
<settlement>
<li>Berne</li>
</settlement>
<orgName>
<li>Université de Berne</li>
</orgName>
</list>
<tree>
<country name="Suisse">
<noRegion>
<name sortKey="Calmy, Alexandra" sort="Calmy, Alexandra" uniqKey="Calmy A" first="Alexandra" last="Calmy">Alexandra Calmy</name>
</noRegion>
<name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
</country>
<country name="France">
<noRegion>
<name sortKey="Balestre, Eric" sort="Balestre, Eric" uniqKey="Balestre E" first="Eric" last="Balestre">Eric Balestre</name>
</noRegion>
<name sortKey="Bonnet, Fabrice" sort="Bonnet, Fabrice" uniqKey="Bonnet F" first="Fabrice" last="Bonnet">Fabrice Bonnet</name>
<name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="François" last="Dabis">François Dabis</name>
<name sortKey="Delaporte, Eric" sort="Delaporte, Eric" uniqKey="Delaporte E" first="Eric" last="Delaporte">Eric Delaporte</name>
<name sortKey="Thiebaut, Rodolphe" sort="Thiebaut, Rodolphe" uniqKey="Thiebaut R" first="Rodolphe" last="Thiébaut">Rodolphe Thiébaut</name>
</country>
<country name="Afrique du Sud">
<noRegion>
<name sortKey="Boulle, Andrew" sort="Boulle, Andrew" uniqKey="Boulle A" first="Andrew" last="Boulle">Andrew Boulle</name>
</noRegion>
<name sortKey="Mcintyre, James" sort="Mcintyre, James" uniqKey="Mcintyre J" first="James" last="Mcintyre">James Mcintyre</name>
<name sortKey="Mcphail, Patrick" sort="Mcphail, Patrick" uniqKey="Mcphail P" first="Patrick" last="Mcphail">Patrick Mcphail</name>
<name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name>
</country>
<country name="Brésil">
<noRegion>
<name sortKey="Sprinz, Eduardo" sort="Sprinz, Eduardo" uniqKey="Sprinz E" first="Eduardo" last="Sprinz">Eduardo Sprinz</name>
</noRegion>
<name sortKey="Schechter, Mauro" sort="Schechter, Mauro" uniqKey="Schechter M" first="Mauro" last="Schechter">Mauro Schechter</name>
</country>
<country name="Côte d'Ivoire">
<noRegion>
<name sortKey="Messou, Eugene" sort="Messou, Eugene" uniqKey="Messou E" first="Eugène" last="Messou">Eugène Messou</name>
</noRegion>
</country>
<country name="Maroc">
<noRegion>
<name sortKey="El Filali, Kamal" sort="El Filali, Kamal" uniqKey="El Filali K" first="Kamal" last="El Filali">Kamal El Filali</name>
</noRegion>
</country>
<country name="Inde">
<noRegion>
<name sortKey="Kumarasamy, N" sort="Kumarasamy, N" uniqKey="Kumarasamy N" first="N" last="Kumarasamy">N. Kumarasamy</name>
</noRegion>
</country>
<country name="Ouganda">
<noRegion>
<name sortKey="Bangsberg, David" sort="Bangsberg, David" uniqKey="Bangsberg D" first="David" last="Bangsberg">David Bangsberg</name>
</noRegion>
</country>
<country name="Pays-Bas">
<noRegion>
<name sortKey="Van Der Borght, Stefaan" sort="Van Der Borght, Stefaan" uniqKey="Van Der Borght S" first="Stefaan" last="Van Der Borght">Stefaan Van Der Borght</name>
</noRegion>
</country>
<country name="Argentine">
<noRegion>
<name sortKey="Zala, Carlos" sort="Zala, Carlos" uniqKey="Zala C" first="Carlos" last="Zala">Carlos Zala</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>

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