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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-Drapalos, A; ... EuroSIDA Study Grp, ; + view all (2010) Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy. ANTIVIR THER , 15 (4) 563 - 570. 10.3851/IMP1559.

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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% Cl -5.3-11.5) and decreased when viral load was >= 10,000 copies/ml (-14.8 cells/mm(3),, 95% Cl -4.5 - -25.1). Patients taking a boosted protease inhibitor (PI) regimen had more positive annual CD4(+) T-cell count changes than patientstaking 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 -21-30.4) 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 >= 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% Cl -33.8 - -3.5) and decreased at a faster rate when the viral load was >= 10,000 copies/int (-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
DOI: 10.3851/IMP1559
Keywords: HUMAN-IMMUNODEFICIENCY-VIRUS, HIV-INFECTED PATIENTS, VIROLOGICAL FAILURE, LYMPHOCYTE COUNT, DRUG CLASSES, PREDICTORS, INHIBITORS, MORTALITY, DECLINE, FITNESS
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/138775
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