CD4 cell count response to first-line combination ART in HIV-2+ patients compared with HIV-1+ patients: a multinational, multicohort European study

Abstract

A poorer CD4 cell increase during first-line cART was observed in HIV-2+ patients, even after adjusting for pretreatment pVL and other potential confounders. Our results underline the need to identify more potent therapeutic regimens or strategies against HIV-2.

British HIV Association guidelines for the management of HIV‐2 2021

“…Results of the single‐arm trial of treatment with elvitegravir‐based therapy suggested improved CD4 count increase when starting treatment with >500 cells/mm 3 [104]. Similarly, slow recovery of CD4 counts was shown in a wider European study [60], in a French cohort [105] and in a Gambian cohort [59]. However, one larger prospective cohort study in six West African countries found better CD4 count recovery in patients with lower baseline CD4 counts [42].…”

“…Immune reconstitution may be slower among people with HIV‐2 than among those with HIV‐1, despite a higher mean baseline CD4 count [59,60]. An observational cohort study in West Africa showed that, although slower, the difference in CD4 count recovery had equalised between people with HIV‐1 and HIV‐2 by 24 months, with no difference in overall mortality [59].…”

“…However, this finding was not replicated in another observational study using data from the COHERE HIV‐1 and ACHI E V 2E HIV‐2 European cohorts. Here, the mean observed change from treatment start to 12 months was +105 cells/mm 3 in people with HIV‐2 and +202 cells/mm 3 in those with HIV‐1, with an observed difference between groups of 97 cells/mm 3 /year [60]. This effect persisted when adjusted for pre‐treatment viral load and ART regimen [60].…”

“…Therefore, asymptomatic individuals with CD4 cell counts of >500 cells/mm 3 who have decided to defer treatment may undergo 6‐monthly monitoring if their CD4 cell decline is slow. CD4 cell count response to first‐line treatment is poorer in HIV‐2 compared to HIV‐1, particularly at lower CD4 cell counts [60]. More frequent CD4 cell count monitoring may therefore be needed in those commencing treatment, particularly if the nadir CD4 cell count is low.…”

Long-term immunological responses to treatment among HIV-2 patients in Côte d’Ivoire

“…Specifically, reports indicate that both reduction in viral load [18] and CD4 recovery [19] are suboptimal for HIV-2 patients during the first 12 months of ART, compared to patients with HIV-1. Diminished CD4 recovery in patients with HIV-2 was even observed after adjustment for pretreatment plasma viral load [20], which some hypotheses credit as the cause of poor CD4 recovery.…”