Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings.
Identifieur interne : 000225 ( France/Analysis ); précédent : 000224; suivant : 000226Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings.
Auteurs : Alexandra Calmy [Suisse] ; Eric Balestre [France] ; Fabrice Bonnet [France] ; Andrew Boulle [Afrique du Sud] ; Eduardo Sprinz [Brésil] ; Robin Wood [Afrique du Sud] ; Eric Delaporte [France] ; Eugène Messou [Côte d'Ivoire] ; James Mcintyre [Afrique du Sud] ; Kamal El Filali [Maroc] ; Mauro Schechter [Brésil] ; N. Kumarasamy [Inde] ; David Bangsberg [Ouganda] ; Patrick Mcphail [Afrique du Sud] ; Stefaan Van Der Borght [Pays-Bas] ; Carlos Zala [Argentine] ; Matthias Egger [Suisse] ; Rodolphe Thiébaut [France] ; François Dabis [France]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2012-06-28.
English descriptors
Abstract
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: 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 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/uL. 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.
Url:
Affiliations:
- Afrique du Sud, Argentine, Brésil, Côte d'Ivoire, France, Inde, Maroc, Ouganda, Pays-Bas, Suisse
- Canton de Berne
- Berne
- Université de Berne
Links toward previous steps (curation, corpus...)
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- to stream Hal, to step Curation: 000147
- to stream Hal, to step Checkpoint: 000214
- to stream Main, to step Merge: 000715
- to stream Main, to step Curation: 000714
- to stream Main, to step Exploration: 000714
- to stream France, to step Extraction: 000225
Links to Exploration step
Hal:inserm-00788673Le document en format XML
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first="Robin" last="Wood">Robin Wood</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-214703" status="INCOMING"><orgName>Gugulethu ART Programme</orgName><desc><address><addrLine>Gugulethu</addrLine><country key="ZA"></country></address></desc><listRelation><relation active="#struct-352300" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-352300" type="direct"><org type="institution" xml:id="struct-352300" status="INCOMING"><orgName>Gugulethu ART Programme</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Afrique du Sud</country></affiliation></author><author><name sortKey="Delaporte, Eric" sort="Delaporte, Eric" uniqKey="Delaporte E" first="Eric" last="Delaporte">Eric Delaporte</name><affiliation wicri:level="1"><hal:affiliation type="institution" xml:id="struct-67872" status="VALID"><orgName>Institut de Recherche pour le Développement</orgName><orgName type="acronym">IRD</orgName><desc><address><addrLine>SiègeLe Sextant 44, bd de DunkerqueCS 9000913572 Marseille cedex 02</addrLine><country key="FR"></country></address><ref type="url">http://www.ird.fr/</ref></desc></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Messou, Eugene" sort="Messou, Eugene" uniqKey="Messou E" first="Eugène" last="Messou">Eugène Messou</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-214705" status="INCOMING"><orgName>Centre de Prise en Charge, de Recherche et de Formation sur le VIH/SIDA</orgName><desc><address><addrLine>Abidjan</addrLine><country key="CI"></country></address></desc><listRelation><relation active="#struct-352313" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-352313" type="direct"><org type="institution" xml:id="struct-352313" status="INCOMING"><orgName>CePReF</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Côte d'Ivoire</country></affiliation></author><author><name sortKey="Mcintyre, James" sort="Mcintyre, James" uniqKey="Mcintyre J" first="James" last="Mcintyre">James Mcintyre</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-214706" status="INCOMING"><orgName>Perinatal HIV Research Unit</orgName><desc><address><addrLine>Soweto</addrLine><country key="ZA"></country></address></desc><listRelation><relation active="#struct-352301" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-352301" type="direct"><org type="institution" xml:id="struct-352301" status="INCOMING"><orgName>Operational Research on ART (OPERA)</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Afrique du Sud</country></affiliation></author><author><name sortKey="El Filali, Kamal" sort="El Filali, Kamal" uniqKey="El Filali K" first="Kamal" last="El Filali">Kamal El Filali</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-214707" status="INCOMING"><orgName>Service des Maladies Infectieuses</orgName><desc><address><addrLine>Casablanca</addrLine><country key="MA"></country></address></desc><listRelation><relation active="#struct-352302" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-352302" type="direct"><org type="institution" xml:id="struct-352302" status="INCOMING"><orgName>Hôpital Ibn Rochd</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Maroc</country></affiliation></author><author><name sortKey="Schechter, Mauro" sort="Schechter, Mauro" uniqKey="Schechter M" first="Mauro" last="Schechter">Mauro Schechter</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-214708" status="INCOMING"><orgName>Rio HIV Cohort</orgName><desc><address><addrLine>Rio de Janeiro</addrLine><country key="BR"></country></address></desc><listRelation><relation active="#struct-352303" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-352303" type="direct"><org type="institution" xml:id="struct-352303" status="INCOMING"><orgName>Rio HIV Cohort</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Brésil</country></affiliation></author><author><name sortKey="Kumarasamy, N" sort="Kumarasamy, N" uniqKey="Kumarasamy N" first="N" last="Kumarasamy">N. Kumarasamy</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-214709" status="INCOMING"><orgName>YRG Centre for AIDS Research and Education</orgName><desc><address><addrLine>Chennai</addrLine><country key="IN"></country></address></desc><listRelation><relation active="#struct-352304" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-352304" type="direct"><org type="institution" xml:id="struct-352304" status="INCOMING"><orgName>YRG Centre for AIDS Research and Education</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Inde</country></affiliation></author><author><name sortKey="Bangsberg, David" sort="Bangsberg, David" uniqKey="Bangsberg D" first="David" last="Bangsberg">David Bangsberg</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-214710" status="INCOMING"><orgName>Immune Suppression Syndrome Clinic (ISS)</orgName><desc><address><addrLine>Mbarara</addrLine><country key="UG"></country></address></desc><listRelation><relation active="#struct-352305" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-352305" type="direct"><org type="institution" xml:id="struct-352305" status="INCOMING"><orgName>Immune Suppression Syndrome Clinic (ISS)</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Ouganda</country></affiliation></author><author><name sortKey="Mcphail, Patrick" sort="Mcphail, Patrick" uniqKey="Mcphail P" first="Patrick" last="Mcphail">Patrick Mcphail</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-214711" status="INCOMING"><orgName>Helen Joseph Hospital Themba Lethu Clinic</orgName><desc><address><addrLine>Johannesburg</addrLine><country key="ZA"></country></address></desc><listRelation><relation active="#struct-352306" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-352306" type="direct"><org type="institution" xml:id="struct-352306" status="INCOMING"><orgName>Helen Joseph Hospital Themba Lethu Clinic</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Afrique du Sud</country></affiliation></author><author><name sortKey="Van Der Borght, Stefaan" sort="Van Der Borght, Stefaan" uniqKey="Van Der Borght S" first="Stefaan" last="Van Der Borght">Stefaan Van Der Borght</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-44269" status="INCOMING"><orgName>Heineken International Health Affairs</orgName><desc><address><addrLine>Amsterdam</addrLine><country key="NL"></country></address></desc><listRelation><relation active="#struct-310676" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-310676" type="direct"><org type="institution" xml:id="struct-310676" status="INCOMING"><orgName>Heineken International Health Affairs</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Pays-Bas</country></affiliation></author><author><name sortKey="Zala, Carlos" sort="Zala, Carlos" uniqKey="Zala C" first="Carlos" last="Zala">Carlos Zala</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-214713" status="INCOMING"><orgName>Prospective Evaluation in the Use and Monitoring of Antiretrovirals in Argentina</orgName><desc><address><addrLine>Buenos Aires</addrLine><country key="AR"></country></address></desc><listRelation><relation active="#struct-352314" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-352314" type="direct"><org type="institution" xml:id="struct-352314" status="INCOMING"><orgName>PUMA</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Argentine</country></affiliation></author><author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-95839" status="INCOMING"><orgName>Institute of Social and Preventive Medicine</orgName><orgName type="acronym">ISPM</orgName><desc><address><country key="CH"></country></address></desc><listRelation><relation active="#struct-300574" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-300574" type="direct"><org type="institution" xml:id="struct-300574" status="INCOMING"><orgName>University of Bern</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region nuts="3" type="region">Canton de Berne</region></placeName><orgName type="university">Université de Berne</orgName></affiliation></author><author><name sortKey="Thiebaut, Rodolphe" sort="Thiebaut, Rodolphe" uniqKey="Thiebaut R" first="Rodolphe" last="Thiébaut">Rodolphe Thiébaut</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-55677" status="VALID"><orgName>Epidémiologie et Biostatistique [Bordeaux]</orgName><desc><address><addrLine>146, rue Léo-Saignat 33076 Bordeaux</addrLine><country key="FR"></country></address></desc><listRelation><relation name="U897" active="#struct-303623" type="direct"></relation><relation active="#struct-302259" type="direct"></relation><relation active="#struct-91134" type="direct"></relation></listRelation><tutelles><tutelle name="U897" active="#struct-303623" type="direct"><org type="institution" xml:id="struct-303623" status="VALID"><idno type="IdRef">026388278</idno><orgName>Institut National de la Santé et de la Recherche Médicale</orgName><orgName type="acronym">INSERM</orgName><desc><address><addrLine>101, rue de Tolbiac, 75013 Paris </addrLine><country key="FR"></country></address><ref type="url">http://www.inserm.fr</ref></desc></org></tutelle><tutelle active="#struct-302259" type="direct"><org type="institution" xml:id="struct-302259" status="VALID"><orgName>Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle><tutelle active="#struct-91134" type="direct"><org type="institution" xml:id="struct-91134" status="OLD"><orgName>Université Bordeaux Segalen - Bordeaux 2</orgName><desc><address><addrLine>146 rue Léo Saignat - 33076 Bordeaux cedex</addrLine><country key="FR"></country></address><ref type="url">http://www.univ-bordeauxsegalen.fr/</ref></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author><author><name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="François" last="Dabis">François Dabis</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-55677" status="VALID"><orgName>Epidémiologie et Biostatistique [Bordeaux]</orgName><desc><address><addrLine>146, rue Léo-Saignat 33076 Bordeaux</addrLine><country key="FR"></country></address></desc><listRelation><relation name="U897" active="#struct-303623" type="direct"></relation><relation active="#struct-302259" type="direct"></relation><relation active="#struct-91134" type="direct"></relation></listRelation><tutelles><tutelle name="U897" active="#struct-303623" type="direct"><org type="institution" xml:id="struct-303623" status="VALID"><idno type="IdRef">026388278</idno><orgName>Institut National de la Santé et de la Recherche Médicale</orgName><orgName type="acronym">INSERM</orgName><desc><address><addrLine>101, rue de Tolbiac, 75013 Paris </addrLine><country key="FR"></country></address><ref type="url">http://www.inserm.fr</ref></desc></org></tutelle><tutelle active="#struct-302259" type="direct"><org type="institution" xml:id="struct-302259" status="VALID"><orgName>Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle><tutelle active="#struct-91134" type="direct"><org type="institution" xml:id="struct-91134" status="OLD"><orgName>Université Bordeaux Segalen - Bordeaux 2</orgName><desc><address><addrLine>146 rue Léo Saignat - 33076 Bordeaux cedex</addrLine><country key="FR"></country></address><ref type="url">http://www.univ-bordeauxsegalen.fr/</ref></desc></org></tutelle></tutelles></hal:affiliation><country>France</country></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="ISSN">1471-2334</idno><imprint><date type="datePub">2012-06-28</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="mix" xml:lang="en"><term>CD4 count</term><term>CD4 slope</term><term>HIV-1</term><term>HIV-RNA threshold</term><term>Resource limited settings</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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: 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 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/uL. 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.</div></front></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Argentine</li><li>Brésil</li><li>Côte d'Ivoire</li><li>France</li><li>Inde</li><li>Maroc</li><li>Ouganda</li><li>Pays-Bas</li><li>Suisse</li></country><region><li>Canton de Berne</li></region><settlement><li>Berne</li></settlement><orgName><li>Université de Berne</li></orgName></list><tree><country name="Suisse"><noRegion><name sortKey="Calmy, Alexandra" sort="Calmy, Alexandra" uniqKey="Calmy A" first="Alexandra" last="Calmy">Alexandra Calmy</name></noRegion><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name></country><country name="France"><noRegion><name sortKey="Balestre, Eric" sort="Balestre, Eric" uniqKey="Balestre E" first="Eric" last="Balestre">Eric Balestre</name></noRegion><name sortKey="Bonnet, Fabrice" sort="Bonnet, Fabrice" uniqKey="Bonnet F" first="Fabrice" last="Bonnet">Fabrice Bonnet</name><name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="François" last="Dabis">François Dabis</name><name sortKey="Delaporte, Eric" sort="Delaporte, Eric" uniqKey="Delaporte E" first="Eric" last="Delaporte">Eric Delaporte</name><name sortKey="Thiebaut, Rodolphe" sort="Thiebaut, Rodolphe" uniqKey="Thiebaut R" first="Rodolphe" last="Thiébaut">Rodolphe Thiébaut</name></country><country name="Afrique du Sud"><noRegion><name sortKey="Boulle, Andrew" sort="Boulle, Andrew" uniqKey="Boulle A" first="Andrew" last="Boulle">Andrew Boulle</name></noRegion><name sortKey="Mcintyre, James" sort="Mcintyre, James" uniqKey="Mcintyre J" first="James" last="Mcintyre">James Mcintyre</name><name sortKey="Mcphail, Patrick" sort="Mcphail, Patrick" uniqKey="Mcphail P" first="Patrick" last="Mcphail">Patrick Mcphail</name><name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name></country><country name="Brésil"><noRegion><name sortKey="Sprinz, Eduardo" sort="Sprinz, Eduardo" uniqKey="Sprinz E" first="Eduardo" last="Sprinz">Eduardo Sprinz</name></noRegion><name sortKey="Schechter, Mauro" sort="Schechter, Mauro" uniqKey="Schechter M" first="Mauro" last="Schechter">Mauro Schechter</name></country><country name="Côte d'Ivoire"><noRegion><name sortKey="Messou, Eugene" sort="Messou, Eugene" uniqKey="Messou E" first="Eugène" last="Messou">Eugène Messou</name></noRegion></country><country name="Maroc"><noRegion><name sortKey="El Filali, Kamal" sort="El Filali, Kamal" uniqKey="El Filali K" first="Kamal" last="El Filali">Kamal El Filali</name></noRegion></country><country name="Inde"><noRegion><name sortKey="Kumarasamy, N" sort="Kumarasamy, N" uniqKey="Kumarasamy N" first="N" last="Kumarasamy">N. Kumarasamy</name></noRegion></country><country name="Ouganda"><noRegion><name sortKey="Bangsberg, David" sort="Bangsberg, David" uniqKey="Bangsberg D" first="David" last="Bangsberg">David Bangsberg</name></noRegion></country><country name="Pays-Bas"><noRegion><name sortKey="Van Der Borght, Stefaan" sort="Van Der Borght, Stefaan" uniqKey="Van Der Borght S" first="Stefaan" last="Van Der Borght">Stefaan Van Der Borght</name></noRegion></country><country name="Argentine"><noRegion><name sortKey="Zala, Carlos" sort="Zala, Carlos" uniqKey="Zala C" first="Carlos" last="Zala">Carlos Zala</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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