Influence of lifelong cumulative HIV viremia on long-term recovery of CD4+ cell count and CD4+/CD8+ ratio among patients on combination antiretroviral therapy

Seng, Rémonie; Goujard, Cécile; Krastinova, Evguenia; Miailhes, Patrick; Orr, Sylvie; Molina, Jean‐Michel; Saada, M.; Piroth, Lionel; Rouzioux, Christine; Meyer, Laurence

doi:10.1097/qad.0000000000000571

Cited by 19 publications

(7 citation statements)

References 33 publications

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“…Baseline HIV-1 genotyping test was conducted, CD4+ T-cell counts and plasma HIV-1 RNA measurements were taken prior to initiation of cART. We analyzed the immunological response to cART by measuring the rate of CD4+ T-cell recovery, as defined by the time to achieve CD4+ T-cell count to ≥350 or ≥500 cells/μL [ 10 ].…”

Section: Methodsmentioning

confidence: 99%

Impact of HIV-1 Subtype on the Time to CD4+ T-Cell Recovery in Combination Antiretroviral Therapy (cART)-Experienced Patients

et al. 2015

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Human immunodeficiency virus type 1 (HIV-1) subtypes have been shown to differ in the rate of clinical progression. We studied the association between HIV-1 subtypes and the rate of CD4+ T-cell recovery in a longitudinal cohort of patients on combination antiretroviral therapy (cART). We studied 103 patients infected with CRF01_AE (69%) and subtype B (31%) who initiated cART between 2006 and 2013. Demographic data, CD4+ T-cell counts and HIV-1 viral load were abstracted from patient medical charts. Kaplan-Meier was used to estimate the time to CD4+ T-cell count increase to ≥350 between subtypes and effects of covariates were analysed using Cox proportional hazards. An 87% of the study population were male adults (mean age of 38.7 years old). Baseline CD4+ T-cell counts and viral loads, age at cART initiation, sex, ethnicity and co-infection did not differ significantly between subtypes. A shorter median time for CD4+ T-cell count increase to ≥350 cells/μL was observed for CRF01_AE (546 days; 95% confidence interval [CI], 186–906 days; P = .502) compared to subtype B (987 days; 95% CI, 894–1079 days). In multivariate analysis, female sex was significantly associated with a 2.7 times higher chance of achieving CD4+ T-cell recovery (adjusted hazard ratio [HR], 2.75; 95% CI, 1.21–6.22; P = .025) and both baseline CD4+ T-cell count (P = .001) and viral load (P = .001) were important predictors for CD4+ T-cell recovery. Immunological recovery correlated significantly with female sex, baseline CD4+ T-cell counts and viral load but not subtype.

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Section: Methodsmentioning

confidence: 99%

Impact of HIV-1 Subtype on the Time to CD4+ T-Cell Recovery in Combination Antiretroviral Therapy (cART)-Experienced Patients

et al. 2015

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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 .…”

Section: Potential Mechanisms Of Incomplete 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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“…Conversely, if ART begins during chronic HIV, then the majority of patients will fail to normalize their ratio even after 14 years of viral suppression and restoration of CD4 levels to >500 [ 27 ]. Treatment interruptions are also deleterious to the ratio, so early initiation of ART and continuous adherence to therapy should be stressed [ 38 ].…”

Section: What Alters the Cd4/cd8 Ratio And Do Other Pathogens Aside mentioning

confidence: 99%

Imbalance in the game of T cells: What can the CD4/CD8 T-cell ratio tell us about HIV and health?

2017

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Influence of lifelong cumulative HIV viremia on long-term recovery of CD4+ cell count and CD4+/CD8+ ratio among patients on combination antiretroviral therapy

Abstract: Our results underline the critical need in early-treated patients to maintain adherence, in order to limit cumulative HIV viremia and optimize immunological recovery, notably the CD4/CD8 ratio.

Cited by 19 publications

References 33 publications

Impact of HIV-1 Subtype on the Time to CD4+ T-Cell Recovery in Combination Antiretroviral Therapy (cART)-Experienced Patients

Impact of HIV-1 Subtype on the Time to CD4+ T-Cell Recovery in Combination Antiretroviral Therapy (cART)-Experienced Patients

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

Imbalance in the game of T cells: What can the CD4/CD8 T-cell ratio tell us about HIV and health?

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