Predictors of suboptimal CD4 response among women achieving virologic suppression in a randomized antiretroviral treatment trial, Africa

BMC Infectious Diseases

Shahin Lockman⁵  Michael D Hughes⁶  Judith Currier²  Robert Salata⁷  Anthony Ogwu³  Fred Sawe⁴  Douglas Shaffer⁴  Kara Wools Kaloustian¹  Yu Zheng⁶  Aida Asmelash³ 

[1] Indiana University, Indianapolis, USA;University of California, Los Angeles, LA, USA;Botswana Harvard School of Public Health AIDS Initiative Partnership, Gaborone, Botswana;Walter Reed Project, Kericho, Kenya;Brigham and Women’s Hospital, Boston, MA, USA;Harvard School of Public Health, Boston, MA, USA;Case Western Reserve University, Cleveland, OH, USA

关键词: CD4;    Immune response;    HAART;    Antiretroviral therapy;    HIV;   

Others  :  1127541
DOI  :  10.1186/1471-2334-14-331

 received in 2013-10-09, accepted in 2014-04-09,  发布年份 2014

【 摘 要 】

Background

A subset of HIV-1 infected patients starting highly active antiretroviral treatment (HAART) experience suboptimal CD4 response (SCR) despite virologic suppression. We studied the rate of and risk factors for SCR among women starting HAART in the ACTG A5208 study conducted in 7 African countries. 741 HAART-naive women with screening CD4 count <200 cells/μL were randomized to start HAART with Tenofovir/Emtricitabine plus either Nevirapine or Lopinavir/Ritonavir.

Methods

This analysis includes the 625 women who remained on-study through 48 weeks without experiencing protocol-defined virologic failure. We defined SCR as < 100 CD4 cells/μL increase from baseline and absolute CD4 cell count < 350 cells/μL, both at 48 weeks after HAART initiation.

Results

The baseline characteristics for the 625 women prior to HAART initiation were: median age 33 years, screening CD4 count 134 cells/μL, and HIV-1 RNA 5.1 log₁₀ copies/mL; 184 (29%) were WHO Stage 3 or 4.

Seventy one (11%) of these 625 women experienced SCR. Baseline factors independently associated with increased odds of SCR included older age, lower HIV-1 RNA, positive Hepatitis B surface antigen, and site location. At 96 weeks, only 6% of the SCR group had CD4 ≥ 350 cells/μL compared with 67% in the non SCR group.

Conclusion

After starting HAART, 11% of women with virologic suppression through 48 weeks experienced SCR. These patients were also less likely to achieve CD4 ≥ 350 cells/μL by 96 weeks. The underlying causes and long term clinical implications of SCR deserve further investigation.

Trial registration

Clinicaltrials.gov Identifier: NCT00089505

【 授权许可】

   
2014 Asmelash et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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