Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings

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dc.contributor.authorCalmy, Alexandraen_ZA
dc.contributor.authorBalestre, Ericen_ZA
dc.contributor.authorBonnet, Fabriceen_ZA
dc.contributor.authorBoulle, Andrewen_ZA
dc.contributor.authorSprinz, Eduardoen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorDelaporte, Ericen_ZA
dc.contributor.authorMessou, Eugeneen_ZA
dc.contributor.authorMcIntyre, Jamesen_ZA
dc.contributor.authorEl Filali, Kamalen_ZA
dc.contributor.authorSchechter, Mauroen_ZA
dc.contributor.authorKumarasamy, Nen_ZA
dc.contributor.authorBangsberg, Daviden_ZA
dc.contributor.authorMcPhail, Patricken_ZA
dc.contributor.authorVan Der Borght,en_ZA
dc.date.accessioned2015-11-18T04:02:57Z
dc.date.available2015-11-18T04:02:57Z
dc.date.issued2012en_ZA
dc.description.abstractBACKGROUND: 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:Naive 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 12months 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 1.6years, a median age of 34years, and a median CD4 cell count at ART initiation of 107 cells/muL. All patients with suppressed HIV-RNA at M12 had a continuous increase in CD4 cell count up to 18months 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.en_ZA
dc.identifier.apacitationCalmy, A., Balestre, E., Bonnet, F., Boulle, A., Sprinz, E., Wood, R., ... (2012). Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/15105en_ZA
dc.identifier.chicagocitationCalmy, Alexandra, Eric Balestre, Fabrice Bonnet, Andrew Boulle, Eduardo Sprinz, Robin Wood, Eric Delaporte, et al "Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings." <i>BMC Infectious Diseases</i> (2012) http://hdl.handle.net/11427/15105en_ZA
dc.identifier.citationCalmy, A., Balestre, E., Bonnet, F., Boulle, A., Sprinz, E., Wood, R., ... & Dabis, F. (2012). Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings. BMC infectious diseases, 12(1), 147.en_ZA
dc.identifier.ris TY - Journal Article AU - Calmy, Alexandra AU - Balestre, Eric AU - Bonnet, Fabrice AU - Boulle, Andrew AU - Sprinz, Eduardo AU - Wood, Robin AU - Delaporte, Eric AU - Messou, Eugene AU - McIntyre, James AU - El Filali, Kamal AU - Schechter, Mauro AU - Kumarasamy, N AU - Bangsberg, David AU - McPhail, Patrick AU - Van Der Borght, AB - 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:Naive 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 12months 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 1.6years, a median age of 34years, and a median CD4 cell count at ART initiation of 107 cells/muL. All patients with suppressed HIV-RNA at M12 had a continuous increase in CD4 cell count up to 18months 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. DA - 2012 DB - OpenUCT DO - 10.1186/1471-2334-12-147 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings TI - Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings UR - http://hdl.handle.net/11427/15105 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15105
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-12-147
dc.identifier.vancouvercitationCalmy A, Balestre E, Bonnet F, Boulle A, Sprinz E, Wood R, et al. Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings. BMC Infectious Diseases. 2012; http://hdl.handle.net/11427/15105.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2012 Calmy et al.; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherCD4 cell countsen_ZA
dc.subject.otherlow or moderate-level viremiaen_ZA
dc.subject.otherAntiretroviral treatment (ART)en_ZA
dc.titleMean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settingsen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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