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Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy

Mocroft, A; Phillips, AN; Ledergerber, B; Smith, C; Bogner, JR; Lacombe, K; Wiercinska-Drapalo, A; ... Lundgren, JD; + view all (2010) Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy. Antivir.Ther. , 15 (4) pp. 563-570.

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Abstract

BACKGROUND: Patients receiving combination antiretroviral therapy (cART) might continue treatment with a virologically failing regimen. We sought to identify annual change in CD4(+) T-cell count according to levels of viraemia in patients on cART. METHODS: A total of 111,371 CD4(+) T-cell counts and viral load measurements in 8,227 patients were analysed. Annual change in CD4(+) T-cell numbers was estimated using mixed models. RESULTS: After adjustment, the estimated average annual change in CD4(+) T-cell count significantly increased when viral load was <500 copies/ml (30.4 cells/mm(3), 95% confidence interval [CI] 26.6-34.3), was stable when viral load was 500-9,999 copies/ml (3.1 cells/mm(3), 95% CI -5.3-11.5) and decreased when viral load was > or =10,000 copies/ml (-14.8 cells/mm(3), 95% CI -4.5--25.1). Patients taking a boosted protease inhibitor (PI) regimen had more positive annual CD4(+) T-cell count changes than patients taking other regimens for any given viral load strata: 30.9 cells/mm(3) (95% CI 27.7-34.1) when viral load was <500 copies/ml, 14.2 cells/mm(3) (95% CI -2.1-30.4) when viral load was 500-9,999 copies/ml and -19.9 cells/mm(3) (95% CI -36.6--3.3) when viral load was >or =10,000 copies/ml. By contrast, among patients taking a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen, the CD4(+) T-cell count significantly decreased when the viral load was 500-9,999 copies/ml (-18.6 cells/mm(3), 95% CI -33.8--3.5) and decreased at a faster rate when the viral load was > or =10,000 copies/ml (-44.4 cells/mm(3), 95% CI -62.0--26.9; P=0.0012, test for interaction). CONCLUSIONS: On average, CD4(+) T-cell counts did not significantly decrease until the viral load exceeded 10,000 copies/ml in patients treated with a boosted PI-containing cART regimen, but decreased in patients taking an NNRTI-based cART regimen when viral load was 500-9,999 copies/ml

Type: Article
Title: Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy
Additional information: DA - 20100630 IS - 2040-2058 (Electronic) IS - 1359-6535 (Linking) LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't RN - 0 (Anti-HIV Agents) RN - 0 (HIV Protease Inhibitors) RN - 0 (RNA, Viral) RN - 0 (Reverse Transcriptase Inhibitors) SB - IM
Keywords: Adult, Anti-HIV Agents, adverse effects, therapeutic use, CD4 Lymphocyte Count, Drug Therapy,Combination, Female, HIV Infections, drug therapy, immunology, virology, HIV Protease Inhibitors, Hiv-1, drug effects, physiology, Humans, Male, Middle Aged, Rna,Viral, blood, Reverse Transcriptase Inhibitors, Treatment Outcome, Viral Load, Viremia
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
URI: http://discovery.ucl.ac.uk/id/eprint/1327223
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