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

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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https://www.hal.inserm.fr/inserm-00788673
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Submitted on : Thursday, February 14, 2013 - 9:09:57 PM
Last modification on : Tuesday, May 14, 2019 - 6:50:14 PM
Long-term archiving on: : Wednesday, May 15, 2013 - 4:04:16 AM

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Alexandra Calmy, Eric Balestre, Fabrice Bonnet, Andrew Boulle, Eduardo Sprinz, et al.. Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings.. BMC Infectious Diseases, BioMed Central, 2012, 12 (1), pp.147. ⟨10.1186/1471-2334-12-147⟩. ⟨inserm-00788673⟩

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