Background. Although the kinetics of CD+ cell counts have been extensively studied in antiretroviral-naive HIV-infected patients, data on individuals who have failed combination antiretroviral therapy (cART) are lacking. Methods. This analysis was based on the ICONA Foundation Study. Subjects with â¥1 episode of viral suppression after starting first-line cART were included (np3537). Following a viral rebound, patients who achieved another episode of viral suppression could reenter the analysis. The percentage of patients with an increase in CD+ cell count 1300 cells/mm3 was estimated using Kaplan-Meier techniques; the rate of CD+ cell count increase per year was estimated using a multivariable, multilevel linear model with fixed effects of intercept and slope. Multivariable models were also fitted to include several covariates. Results. The median time to reach a CD+ cell count increase <300 cells/mm3 from baseline was significantly associated with the number of failed regimens: 34 months, 41 months, 51 months, and 45 months in subjects without evidence of previous virological failure, or 1, 2, or â¥3 previous virologically failed regimens, respectively (P < .001, by log-rank test). The annual estimated increases in CD+ cell count were 36 cells/mm3 (95% confidence interval [CI], 34-38 cells/mm3), 28 cells/mm3 (95% CI, 11-21 cells/mm3), 31 cells/mm3 (95% CI, 26-36 cells/ mm 3), and 26 cells/mm3 (95% CI, 18-33 cells/mm3), respectively. Differences in the annual CD+ cell count increase were observed between specific antiretrovirals. Conclusions. Subjects with â¥1 virological failure took a longer time to reach a CD+ cell count 1300 cell/ mm3 and had a slower annual increase than those without virological failure. Efforts should be made to optimize first-line cART, because this represents the best chance of achieving an effective CD+ response. © 2010 by the Infectious Diseases Society of America. All rights reserved.
Rate of CD4+ Cell Count Increase over Periods of Viral Load Suppression: Relationship with the Number of Previous Virological Failures / Trotta, M.P., Cozzi lepri, A., Ammassari, A., Vecchiet, J., Cassola, G., Caramello, P., Vullo, V., Soscia, F., Chiodera, A., Ladisa, N., Abeli, C., Cauda, R., Buonuomi, A.R., Antinori, A., Monforte, A.D., Icona Foundation Study, G., Castagna, A.. - In: CLINICAL INFECTIOUS DISEASES. - ISSN 1058-4838. - 51:4(2010), pp. 456-464. [10.1086/655151]
Rate of CD4+ Cell Count Increase over Periods of Viral Load Suppression: Relationship with the Number of Previous Virological Failures
CASTAGNA, ANTONELLA
2010-01-01
Abstract
Background. Although the kinetics of CD+ cell counts have been extensively studied in antiretroviral-naive HIV-infected patients, data on individuals who have failed combination antiretroviral therapy (cART) are lacking. Methods. This analysis was based on the ICONA Foundation Study. Subjects with â¥1 episode of viral suppression after starting first-line cART were included (np3537). Following a viral rebound, patients who achieved another episode of viral suppression could reenter the analysis. The percentage of patients with an increase in CD+ cell count 1300 cells/mm3 was estimated using Kaplan-Meier techniques; the rate of CD+ cell count increase per year was estimated using a multivariable, multilevel linear model with fixed effects of intercept and slope. Multivariable models were also fitted to include several covariates. Results. The median time to reach a CD+ cell count increase <300 cells/mm3 from baseline was significantly associated with the number of failed regimens: 34 months, 41 months, 51 months, and 45 months in subjects without evidence of previous virological failure, or 1, 2, or â¥3 previous virologically failed regimens, respectively (P < .001, by log-rank test). The annual estimated increases in CD+ cell count were 36 cells/mm3 (95% confidence interval [CI], 34-38 cells/mm3), 28 cells/mm3 (95% CI, 11-21 cells/mm3), 31 cells/mm3 (95% CI, 26-36 cells/ mm 3), and 26 cells/mm3 (95% CI, 18-33 cells/mm3), respectively. Differences in the annual CD+ cell count increase were observed between specific antiretrovirals. Conclusions. Subjects with â¥1 virological failure took a longer time to reach a CD+ cell count 1300 cell/ mm3 and had a slower annual increase than those without virological failure. Efforts should be made to optimize first-line cART, because this represents the best chance of achieving an effective CD+ response. © 2010 by the Infectious Diseases Society of America. All rights reserved.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
