@article{ef4264f7867b459db04ef6414c62905f,
title = "Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings",
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: Na{\"i}ve 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/μL. 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.",
keywords = "CD4 count, CD4 slope, HIV-1, HIV-RNA threshold, Resource limited settings",
author = "Alexandra Calmy and Eric Balestre and Fabrice Bonnet and Andrew Boulle and Eduardo Sprinz and Robin Wood and Eric Delaporte and Eug{\`e}ne Messou and James McIntyre and {El Filali}, {Kamal M.} and Mauro Schechter and N. Kumarasamy and David Bangsberg and Patrick McPhail and {Van Der Borght}, Stefaan and Carlos Zala and Matthias Egger and Rodolphe Thi{\'e}baut and Fran{\c c}ois Dabis",
note = "Funding Information: The ART-LINC collaboration of the International epidemiological Databases to Evaluate AIDS (IeDEA) is funded by the US National Institutes of Health (Office of AIDS Research and National Institute of Allergy and Infectious Diseases) and the French Agence Nationale de Recherches sur le Sida et les hepatites virales (ANRS). Centre de Prise en Charge de Recherches et de Formation (CEPREF)/Agence Nationale de Recherches sur le Sida et les hepatitis virales (ANRS) 1203 COTRAME Cohort (Abidjan, C{\^o}te d{\textquoteright}Ivoire); Senegalese Antiretroviral Access Initiative (ISAARV), ANRS 1290 (Dakar, Senegal); Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH), Moi University College of Health Sciences/University of Indiana (Eldoret, Kenya); Adherence Monitoring Uganda (AMU) cohort, Makerere-University of California in San Francisco (UCSF; Kampala, Uganda); Kamuzu Central Hospital/Lighthouse Trust (Lilongwe, Malawi); Connaught Clinic (Harare, Zimbabwe); Gugulethu ART Programme, (Cape Town, South Africa); Khayelitsha ART Programme, (Cape Town, South Africa); Operational Research on ART (OPERA), Perinatal HIV Research Unit (Soweto, South Africa); Morocco Antiretroviral Treatment 14 Cohort, Centre Hospitalier Universitaire (Casablanca, Morocco); MTCT-Plus Initiative, International Center for AIDS Care and Treatment Programs, Mailman School of Public Health, Columbia University, New York, USA; Prospective Evaluation in the Use and Monitoring of Antiretrovirals in Argentina (PUMA), Buenos Aires, Argentina; South Brazil HIV Cohort (SOBRHIV), Hospital de Clinicas (Porto Alegre, Brazil); Rio de Janeiro HIV Cohort, Hospital Universitario Clementino Fraga Filho (Rio de Janeiro, Brazil); Y R Gaitonde Centre for AIDS Research and Education (YRG) Care Cohort (Chennai, India); HIV-NAT, Thai Red Cross AIDS Research Centre (Bangkok, Thailand). Funding Information: The ART-LINC of IeDEA Collaboration was funded by the United States National Institute of Health (NIH - Office of AIDS Research) together with the French Agence Nationale de Recherches sur le Sida et les h{\'e}patites virales (ANRS – grants 12101 and 12138). The IeDEA network is now funded through collaborative agreements by the National Cancer Institute (NCI), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Allergy And Infectious Diseases (NIAID).",
year = "2012",
month = jun,
day = "28",
doi = "10.1186/1471-2334-12-147",
language = "English (US)",
volume = "12",
journal = "BMC Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",
}