Calmy A. auteur aut IRD Balestre E. auteur aut IRD Bonnet F. auteur aut IRD Boulle A. auteur aut IRD Sprinz E. auteur aut IRD Wood R. auteur aut IRD Delaporte Eric auteur aut IRD Messou E. auteur aut IRD McIntyre J. auteur aut IRD El Filali K. M. auteur aut IRD Schechter M. auteur aut IRD Kumarasamy N. auteur aut IRD Bangsberg D. auteur aut IRD McPhail P. auteur aut IRD Van der Borght S. auteur aut IRD Zala C. auteur aut IRD Egger M. auteur aut IRD Thiebaut R. auteur aut IRD Dabis F. auteur aut IRD Art-Linc IeDEA Collaboration Asia auteur aut IRD text journalArticle eng 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. specialized HIV-1 CD4 count CD4 slope HIV-RNA threshold Resource limited settings 052 12 147 2012 1471-2334 https://www.documentation.ird.fr/hor/PAR00010221 10.1186/1471-2334-12-147 1471-2334 https://www.documentation.ird.fr/hor/PAR00010221 IRD - Base Horizon / Pleins textes 2013-04-02 2017-08-23 PAR00010221 fre