CD4 Response Up to 5 Years After Combination Antiretroviral Therapy in Human Immunodeficiency Virus-Infected Patients in Latin America and the Caribbean

Luz, Paula M.; Belaunzarán-Zamudio, Pablo F.; Crabtree-Ramírez, Brenda; Caro‐Vega, Yanink; Hoces, Daniel; Rebeiro, Peter F; Blevins, Meridith; Pape, Jean William; Cortés, Claudia; Padgett, Denis; Cahn, Pedro; Veloso, Valdiléa G.; McGowan, Catherine C.; Grinsztejn, Beatriz; Shepherd, Bryan E.

doi:10.1093/ofid/ofv079

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…Patients with a CD4 + T-cell count <200 cells/µl at the start of treatment had poorer immunologic outcomes than patients with >200 cells/ µl, consistent with the findings of previous studies (Garcia et al, 2004). In this study, most patients had high CD4 + T-cell counts at baseline, higher than those for patients on second-line ART in other studies (Luz et al, 2015), but similar to those reported in another study assessing LPV/r-based second-line ART (Patel et al, 2013). In an Iranian study, the authors reported that mean CD4 + T-cell counts had increased by 139 cells/µl relative to baseline at 12 months (Rasooli-Nejad et al, 2017).…”

Section: Discussionsupporting

confidence: 90%

Efficacy and Tolerability of Lopinavir/Ritonavir- and Efavirenz-Based Initial Antiretroviral Therapy in HIV-1-Infected Patients in a Tertiary Care Hospital in Beijing, China

Wang

Zhou

et al. 2019

Front. Pharmacol.

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Background: Lopinavir/ritonavir (LPV/r) is a major antiretroviral treatment in China, but little is known about the performance of first-line LPV/r-based regimen in treatment-naïve patients with human immunodeficiency virus type 1 (HIV-1) infection. This study aims to assess the efficacy and adverse effect events of LPV/r plus lamivudine and tenofovir or zidovudine as an initial antiretroviral treatment in HIV-1-infected individuals for whom cannot take efavirenz (EFV) or is allergic to EFV. Methods:We performed a retrospective study of patients registering with the China's National Free Antiretroviral Treatment Program from July 2012 to January 2017, followed at a tertiary care hospital in Beijing, China. The primary outcome was the proportion of subjects with HIV-1 RNA ≤40 copies/ml at 6 and 24 months of treatment. We assessed the immunological response and adverse events.Results: In total, 4,862 patients were enrolled in the study and 237 were eligible for analysis in each study arm. During the first six months, virological suppression was better with the LPV/r-based regimen than with the EFV-based regimen (93.80 vs 87.80% for P < 0.05). Viral suppression rates continued to increase until 12 months, remain steady thereafter until 24 months, for both groups. The multilevel analysis revealed that patients in the LPV/r group were more likely to display improvements in CD4 T-cell count over time than those in the EFV group (P < 0.001). Grade 3 or 4 laboratory adverse events were observed in 14 patients (5.91%) from the LPV/r group and three patients (1.20%) in EFV group.Conclusion: Our findings demonstrate that LPV/r-containing regimens are effective and well-tolerated in Chinese treatment-naïve patients with HIV-1 infection.

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Section: Discussionsupporting

confidence: 90%

Efficacy and Tolerability of Lopinavir/Ritonavir- and Efavirenz-Based Initial Antiretroviral Therapy in HIV-1-Infected Patients in a Tertiary Care Hospital in Beijing, China

Wang

Zhou

et al. 2019

Front. Pharmacol.

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“…Patients who died prior to each time point were assigned to have the worst rank measurements (i.e. the lowest CD4 measurement) [24,25]. The probability of a missing value was modelled separately for each laboratory measurement at each time point using logistic regression models that included covariates for site, age, sex, presence of AIDS-defining illness, year of ART initiation, ART regimen, probable route of HIV transmission and the corresponding baseline laboratory measurement.…”

Section: Discussionmentioning

confidence: 99%

Virologic failure and mortality in older ART initiators in a multisite Latin American and Caribbean Cohort

Carriquiry¹,

Giganti

Castilho

et al. 2018

J Intern AIDS Soc

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IntroductionThe “greying” of the HIV epidemic necessitates a better understanding of the healthcare needs of older HIV‐positive adults. As these individuals age, it is unclear whether comorbidities and their associated therapies or the ageing process itself alter the response to antiretroviral therapy (ART). In this study, HIV treatment outcomes and corresponding risk factors were compared between older ART initiators and those who were younger using data from the Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet).Methods HIV‐positive adults (≥18 years) initiating ART at nine sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Patients were classified as older (≥50 years) or younger (<50 years) based on age at ART initiation. ART effectiveness was measured using three outcomes: death, virologic failure and ART treatment modification. Cox regression models for each outcome compared risk between older and younger patients, adjusting for other covariates.ResultsAmong 26,311 patients initiating ART between 1996 and 2016, 3389 (13%) were ≥50 years. The majority of patients in both ≥50 and <50 age groups received a non‐nucleoside reverse transcriptase inhibitor‐based regimen (89% vs. 87%), did not have AIDS at baseline (63% vs. 62%), and were male (59% vs. 58%). Older patients had a higher risk of death (adjusted hazard ratio (aHR) 1.64; 95% confidence intervals (CI): 1.48 to 1.83) and a lower risk of virologic failure (aHR: 0.73; 95% CI: 0.63 to 0.84). There was no difference in risk of ART modification (aHR: 1.00; 95% CI: 0.94 to 1.06). Risk factors for death, virologic failure and treatment modification were similar for each group.ConclusionsOlder age at ART initiation was associated with increased mortality and decreased risk of virologic failure in our cohort of more than 26,000 ART initiators in Latin America and the Caribbean. To the best of our knowledge this is the first study from the region to evaluate ART outcomes in this growing and important population. Given the complexity of issues related to ageing with HIV, a greater understanding is needed in order to properly respond to this shifting epidemic.

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“…In addition to the factors mentioned above, older age, male sex, lower nadir CD4 T‐cell counts, lower CD4/CD8 ratios, and a lower naïve/memory CD4 + T‐cell ratio have been associated with a blunted immunological response to ART treatment. Ethnic origin is also associated with immune recovery . Furthermore, host genetic factors, metabolic characteristics, and specific ART regimens may play a role in incomplete immune recovery.…”

Section: Potential Mechanisms Of Incomplete Immune Reconstitutionmentioning

confidence: 99%

“…Ethnic origin is also associated with immune recovery. [171][172][173][174] Furthermore, host genetic factors, metabolic characteristics, and specific ART regimens may play a role in incomplete immune recovery. Luo…”

Section: Other Factors Associated With Immune Reconstitutionmentioning

confidence: 99%

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

Yang

Zhang

et al. 2020

Journal of Leukocyte Biology

191

214

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The morbidity and mortality of HIV type‐1 (HIV‐1)‐related diseases were dramatically diminished by the grounds of the introduction of potent antiretroviral therapy, which induces persistent suppression of HIV‐1 replication and gradual recovery of CD4+ T‐cell counts. However, ∼10–40% of HIV‐1‐infected individuals fail to achieve normalization of CD4+ T‐cell counts despite persistent virological suppression. These patients are referred to as “inadequate immunological responders,” “immunodiscordant responders,” or “immunological non‐responders (INRs)” who show severe immunological dysfunction. Indeed, INRs are at an increased risk of clinical progression to AIDS and non‐AIDS events and present higher rates of mortality than HIV‐1‐infected individuals with adequate immune reconstitution. To date, the underlying mechanism of incomplete immune reconstitution in HIV‐1‐infected patients has not been fully elucidated. In light of this limitation, it is of substantial practical significance to deeply understand the mechanism of immune reconstitution and design effective individualized treatment strategies. Therefore, in this review, we aim to highlight the mechanism and risk factors of incomplete immune reconstitution and strategies to intervene.

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CD4 Response Up to 5 Years After Combination Antiretroviral Therapy in Human Immunodeficiency Virus-Infected Patients in Latin America and the Caribbean

Cited by 8 publications

References 14 publications

Efficacy and Tolerability of Lopinavir/Ritonavir- and Efavirenz-Based Initial Antiretroviral Therapy in HIV-1-Infected Patients in a Tertiary Care Hospital in Beijing, China

Efficacy and Tolerability of Lopinavir/Ritonavir- and Efavirenz-Based Initial Antiretroviral Therapy in HIV-1-Infected Patients in a Tertiary Care Hospital in Beijing, China

Virologic failure and mortality in older ART initiators in a multisite Latin American and Caribbean Cohort

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

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