Decline of CD4⁺ T-cell count before start of therapy and immunological response to treatment in antiretroviral-naive individuals

Mussini, Cristina, Cossarizza, Andrea, Sabin, Caroline, Babiker, Abdel, De Luca, Andrea, Bucher, Heiner C, Fisher, Martin, Rezza, Giovanni, Porter, Kholoud, Dorrucci, Maria and The CASCADE Collaboration, (2011) Decline of CD4⁺ T-cell count before start of therapy and immunological response to treatment in antiretroviral-naive individuals. AIDS, 25 (8). pp. 1041-1049. ISSN 0269-9370

Full text not available from this repository.

Abstract

OBJECTIVE

Treatment guidelines recommend initiation of therapy for individuals experiencing rapid CD4 cell decline. It is not known, however, whether the rate of CD4 cell decline before combination antiretroviral therapy (cART) is related to immunological response following cART.

METHODS

We estimated precART and postcART CD4 cell slopes by mixed models and categorized patients into two groups according to whether estimated precART slopes were above or below the 75th percentile. We compared immunological responses of the two groups through both mixed models and survival techniques. Models were stratified by CD4 cell at baseline, adjusted for HIV RNA, age, sex, HIV transmission group, year of seroconversion, initiation during primary infection, hepatitis C virus and hepatitis B virus serostatus, and cART class.

RESULTS

Of 2038 eligible patients, 1531 and 507 experienced median (interquartile range) precART CD4 cell slope of −105 (−471 to −61) and −42 (−62 to −80) cells/μl, respectively, over 2 years. After adjusting for potential confounders, individuals with shallower decline experienced a slower rate of CD4 cell recovery following cART initiation of +9.5 [95% confidence interval (CI) +6.6 to +12.2] compared to +13.9 (+13.0 to +14.8) cells/μl per month among those with steeper precART decline (P < 0.001). After stratifying by the baseline CD4 cell count, the adjusted relative hazard of an increase from baseline of more than 50 cells/μl was 0.70 (95% CI 0.62−0.79) for those with a shallower vs. steeper precART decline.

CONCLUSION

Findings highlight the existence of a subgroup of individuals with shallower precART CD4 cell decline who experience poorer CD4 cell increases after cART; new studies in this group may provide information to optimize responses to therapy.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health > RA0644 Individual diseases or groups of diseases, A-Z > RA0644.A25 AIDS. HIV infections
Related URLs:
Depositing User: Ellen Thomas
Date Deposited: 14 Feb 2014 14:32
Last Modified: 14 Feb 2014 14:32
URI: http://sro.sussex.ac.uk/id/eprint/47500
📧 Request an update