%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Calmy, A.
%A Balestre, E.
%A Bonnet, F.
%A Boulle, A.
%A Sprinz, E.
%A Wood, R.
%A Delaporte, Eric
%A Messou, E.
%A McIntyre, J.
%A El Filali, K. M.
%A Schechter, M.
%A Kumarasamy, N.
%A Bangsberg, D.
%A McPhail, P.
%A Van der Borght, S.
%A Zala, C.
%A Egger, M.
%A Thiebaut, R.
%A Dabis, F.
%A Art-Linc IeDEA Collaboration Asia
%T Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings
%D 2012
%L PAR00010221
%G ENG
%J Bmc Infectious Diseases
%@ 1471-2334
%K HIV-1 ; CD4 count ; CD4 slope ; HIV-RNA threshold ; Resource limited ; settings
%M ISI:000315398100001
%P 147
%R 10.1186/1471-2334-12-147
%U https://www.documentation.ird.fr/hor/PAR00010221
%V 12
%W Horizon (IRD)
%X 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/mu L. 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.
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