Immunological Function Restoration with Lopinavir/Ritonavir Versus Efavirenz Containing Regimens in HIV-Infected Patients: A Randomized Clinical Trial

Abstract

CD4+ count increase has been reported to be different with lopinavir/r (LPV/r) and efavirenz (EFV)-containing regimens. The different effect of these two regimens on other immune function parameters and the relationship with the gain of CD4 + count have not been assessed in a randomized clinical trial. Fifty antiretroviral treatment (cART) naïve HIV-infected individuals were randomized to receive LPV/r or EFV both with tenofovir/emtricitabine for 48 weeks. A substudy of immunological function restoration was performed in 22 patients (LPV/r n = 10 and EFV n = 12). Activation, thymic function, apoptosis, senescence, exhaustion, Treg cells, interleukin (IL)-7-receptor/IL-7 system, thymic volume, and lymphoid tissue fibrosis were evaluated at baseline and at week 48. Both groups experienced a CD4 + count increase that was higher in the EFV group (DCD4 + 88 vs. 315 cells/ll LPV/r vs. EFV, respectively, p < 0.001). Despite this difference in CD4 + gain, the change in other immune function parameters was similar in both treatment groups. Most of parameters evaluated tended to normalize after 48 weeks of cART. A significant decrease in levels of activation, senescence, exhaustion, and apoptosis on CD4 + and CD8 + T cells ( p < 0.001 for all) and a significant increase in markers of thymic function, IL-7 receptor, and in the levels of central memory CD4+ T cells and naive subsets of CD8 + T cells ( p < 0.001 for all) with respect to baseline values were observed without any difference between groups. These data indicate that the differences in CD4 + gain with different cART regimens are not immunologically meaningful and might explain the similar clinical efficacy of these regimens.

Telmisartan Therapy Does Not Improve Lymph Node or Adipose Tissue Fibrosis More Than Continued Antiretroviral Therapy Alone

“…Previous studies of lymphoid tissue fibrosis have demonstrated no effect of ART but have only evaluated up to 1 year of treatment [37,44,45]. Thus, fibrosis may be stable early after starting ART, but continued suppressive ART may eventually permit resumption of wound healing processes and modest fibrosis reversal.…”

HIV Case Management Support Service Is Associated with Improved CD4 Counts of Patients Receiving Care at the Antiretroviral Clinic of Pantang Hospital, Ghana

“…The majority of the participants in this Ghana study were on Tenofovir , Lamivudine , and Efavirenz combination therapy. A study conducted in Barcelona, Spain, indicated that a combination regimen boosted the CD4 count and reduces viral load of participants [ 21 ].…”

Protease inhibitor monotherapy is associated with a higher level of monocyte activation, bacterial translocation and inflammation

“…In fact, it has been reported that clinically important CD4+ T lymphocyte count responses are likely to be better defined in terms of absolute postcART CD4+ T lymphocyte counts, rather than change from baseline [ 36 ]. In addition, we have recently reported that differences in CD4+ T lymphocyte gain with different cART regimen are not immunologically meaningful [ 37 ]. Moreover, we have repeated the analysis controlling by time of known HIV infection and CD4+ T lymphocyte count previous to cART and the results were confirmed.…”