Predictors of Success with Highly Active Antiretroviral Therapy in an Antiretroviral-Naive Urban Population

Abstract

Predictors of successful virologic, immunologic, and clinical response with combined antiretroviral therapy (cART) containing a boosted protease inhibitor or a nonnucleoside reverse transcriptase inhibitor were analyzed among an antiretroviral naive (ARV-naive) urban cohort. Measures of success included virologic suppression [HIV-1 viral load (VL) <400 copies/ml], an increase in CD4(+) T cells from baseline of >100 cells/microl, and lack of development of an AIDS-defining illness at 24 and 48 weeks after cART initiation. Two hundred and eighty-seven ARV-naive patients were included in this cohort, of which 76.7% were male and 86.8% were nonwhite. At the time of cART initiation their median age was 39 years, the geometric mean CD4(+) count was 42 cells/microl, and the mean viral load was 5.3 log(10) copies/ml. At 48 weeks, 72% of patients achieved virologic suppression, with> or =90% adherence and high school graduation predicting viral undetectability at 48 weeks. Baseline VL < or =100,000 copies/ml and a CD4(+) cell count >100 cells/microl were associated with viral suppression at 24 weeks [OR (95% CI) = 3.55 (1.29-9.81) and 3.96 (1.19-13.15), respectively]; female gender was associated with a greater increase in CD4(+) cell counts [OR (95% CI) = 7.41 (2.48-22.1)]. CDC stage A1-C2 at baseline predicted lack of clinical progression at 48 weeks. The results of this analysis of an ARV-naive cohort comprised predominantly of indigent, minority patients suggest that men who did not have a high school education and who had advanced HIV infection are less likely to have therapeutic success after cART initiation.

Differences in Response to Antiretroviral Therapy by Sex and Hepatitis C Infection Status

“…[20][21][22][23][24] Similar to the findings of a recent meta-analysis by Tsiara et al, 5 Int, p value for interaction across sex strata. Data are given as hazard ratios (95% confidence intervals) derived from Cox regression models.…”

“…While some studies have found no association of sex with response to ART, [17][18][19] others have suggested that women have superior virologic, immunologic, and clinical outcomes compared with men. [20][21][22][23][24] It is unknown if this is attributable to biological factors, such as pharmacokinetics, 25,26 or behavioral or structural factors, such as adherence 27 or access to or quality of care. 28 Despite evidence that there may be sex differences in both the course of HCV disease and the response to ART among HIV-infected individuals, there have been no studies examining HIV-associated outcomes with respect to both sex and HCV status over time.…”

Trends of Immuno-virological Response Among HIV-Infected Patients Receiving Highly Active Anti-retroviral Therapy at Hawassa, Southern Ethiopia

“…In line with the other studies report [23,24] we found no significant differences in CD4+ reconstitution regarding gender. But other reports indicated that females have better immunological reconstitution compared to males [25,26,27,28]. More over our study indicates lower viral load in female when compared to males at the baseline of ART commencement.…”

Definition of Advanced Age in HIV Infection: Looking for an Age Cut-Off

“…5,8,9,[15][16][17][18][19] In our case the virological response was similar across all age groups but improved significantly in patients over 60 years. The best virological control in elderly patients has been associated with better adherence to antiretroviral therapy (ART), 18,28,[41][42][43] despite the fact that many of them take other treatments (e.g., antihypertensives, antidiabetics). For some authors the best virologic control during the first year of ART in patients ‡ 50 years was entirely explained by better adherence, 18 while others have observed that this better virological control persists regardless of the degree of adherence, the treatment regimen, and the stage of the CDC.…”