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Rate of CD4(+) Cell Count Increase over Periods of Viral Load Suppression: Relationship with the Number of Previous Virological Failures

Trotta, MP; Cozzi-Lepri, A; Ammassari, A; Vecchiet, J; Cassola, G; Caramello, P; Vullo, V; ... ICONA Fdn Study, ; + view all (2010) Rate of CD4(+) Cell Count Increase over Periods of Viral Load Suppression: Relationship with the Number of Previous Virological Failures. CLIN INFECT DIS , 51 (4) 456 - 464. 10.1086/655151.

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Abstract

Background. Although the kinetics of CD4(+) cell counts have been extensively studied in antiretroviral-naive HIV-infected patients, data on individuals who have failed combination antiretroviral therapy (cART) are lacking.Methods. This analysis was based on the ICONA Foundation Study. Subjects with >= 1 episode of viral suppression after starting first-line cART were included (n = 3537). Following a viral rebound, patients who achieved another episode of viral suppression could reenter the analysis. The percentage of patients with an increase in CD4(+) cell count 1300 cells/mm(3) was estimated using Kaplan-Meier techniques; the rate of CD4(+) cell count increase per year was estimated using a multivariable, multilevel linear model with fixed effects of intercept and slope. Multivariable models were also fitted to include several covariates.Results. The median time to reach a CD4(+) cell count increase 1300 cells/mm(3) from baseline was significantly associated with the number of failed regimens: 34 months, 41 months, 51 months, and 45 months in subjects without evidence of previous virological failure, or 1, 2, or >= 3 previous virologically failed regimens, respectively (P<.001 by log-rank test). The annual estimated increases in CD4(+) cell count were 36 cells/mm(3) (95% confidence interval [CI], 34-38 cells/mm(3)), 28 cells/mm(3) (95% CI, 11-21 cells/mm(3)), 31 cells/mm(3) (95% CI, 26-36 cells/mm(3)), and 26 cells/mm(3) (95% CI, 18-33 cells/mm(3)), respectively. Differences in the annual CD4(+) cell count increase were observed between specific antiretrovirals.Conclusions. Subjects with >= 1 virological failure took a longer time to reach a CD4(+) cell count 1300 cell/mm(3) and had a slower annual increase than those without virological failure. Efforts should be made to optimize first-line cART, because this represents the best chance of achieving an effective CD4(+) response.

Type: Article
Title: Rate of CD4(+) Cell Count Increase over Periods of Viral Load Suppression: Relationship with the Number of Previous Virological Failures
DOI: 10.1086/655151
Keywords: ACTIVE ANTIRETROVIRAL THERAPY, HIV-INFECTED PATIENTS, NAIVE PATIENTS, RECOVERY, VIREMIA, COHORT, INDIVIDUALS, CELLS/MM(3), GREATER, REGIMEN
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/106273
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