Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4 + T-cell recovery once HIV-1 suppression is achieved?
Jarrin, Inma (Instituto de Salud Carlos III)
Pantazis, Nikos (Athens University Medical School, Athens, Greece)
Dalmau, Judith (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Phillips, Andrew N. (Research Department of Infection and Population Health)
Olson, Ashley (Medical Research Council Clinical Trials Unit, University College London, London, UK)
Mussini, Cristina (Institute of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy)
Boufassa, Faroudy (Univ Paris-Sud, Le Kremlim Bicetre)
Costagliola, Dominique (INSERM, Paris, France)
Porter, Kholoud (Medical Research Council Clinical Trials Unit, University College London, London, UK)
Blanco, Julià (Universitat de Vic - Universitat Central de Catalunya)
Del Amo, Julia (Instituto de Salud Carlos III)
Martínez Picado, Francisco Javier (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)

Fecha:	2015
Resumen:	This article compares trends in CD4 + T-cell recovery and proportions achieving optimal restoration (≥500 cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors. We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4 + less than 200 cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration. Of 4024 individuals, 294 (7. 3%) were classified as rapid progressors. At the same CD4 + T-cell count at cART start (baseline), rapid progressors experienced faster CD4 + T-cell increases than nonrapid progressors in first month [difference (95% confidence interval) in mean increase/month (square root scale): 1. 82 (1. 61; 2. 04)], which reversed to slightly slower increases in months 1-18 [−0. 05 (−0. 06; −0. 03)] and no significant differences in 18-60 months [−0. 003 (−0. 01; 0. 01)]. Percentage achieving optimal restoration was significantly lower for rapid progressors than nonrapid progressors at months 12 (29. 2 vs. 62. 5%) and 36 (47. 1 vs. 72. 4%) but not at month 60 (70. 4 vs. 71. 8%). These differences disappeared after adjusting for baseline CD4 + T-cell count: odds ratio (95% confidence interval) 0. 86 (0. 61; 1. 20), 0. 90 (0. 38; 2. 17) and 1. 56 (0. 55; 4. 46) at months 12, 36 and 60, respectively. Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4 + T-cell counts than nonrapid progressors, but are less likely to achieve optimal restoration during the first 36 months after cART, mainly because of lower CD4 + T-cell counts at cART initiation.
Ayudas:	European Commission 260694
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	CD4 responses ; HIV-viral suppression ; Rapid progression
Publicado en:	AIDS, Vol. 29 (october 2015) , p. 2323-2333, ISSN 1473-5571

DOI: 10.1097/QAD.0000000000000805
PMID: 26544704

11 p, 679.0 KB

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