Early changes in T-cell activation predict antiretroviral success in salvage therapy of HIV infection.
OBJECTIVE
Because effective antiretroviral therapy (ART) reduces immune activation, we hypothesize that early changes in immune activation are associated with subsequent virologic response to therapy.


METHODS
Observational cohort study.


METHODS
Institutional HIV clinic.


METHODS
Thirty-four adult HIV patients with virologic failure on their current antiretroviral regimen.


METHODS
Change to salvage regimen selected by patient's physician.


METHODS
Measures of immune activation at baseline and at 2, 4, 8, and 24 weeks after enrollment. Data were analyzed by proportional hazards (PH) models.


RESULTS
PH models showed that reductions between baseline and week 2 in expression of CD38 (P = 0.02) or CD95 (P = 0.02) on CD4 T cells were associated with increased likelihood of achieving virologic suppression. Kaplan-Meier analysis demonstrated that patients who had reductions within the first 2 weeks of therapy in CD4 T-cell expression of CD38 (P = 0.003) or CD95 (P = 0.08) were more likely to achieve viral suppression than those who did not.


CONCLUSIONS
Reduced CD4 T-cell expression of CD38 and CD95 occurring within 2 weeks of salvage therapy is associated with subsequent viral suppression. Monitoring CD38 and CD95 may allow earlier assessment of the response to ART.
Shepard
Brett D
BD
Mayo Clinic, Rochester, MN 55905, USA.
Loutfy
Mona R
MR
Raboud
Janet
J
Mandy
Frank
F
Kovacs
Colin M
CM
Diong
Christina
C
Bergeron
Michele
M
Govan
Victoria
V
Rizza
Stacey A
SA
Angel
Jonathan B
JB
Badley
Andrew D
AD
D051997:ADP-ribosyl Cyclase 1 / Q000032:analysis; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D013601:T-Lymphocytes / Q000276:immunology*; D019014:fas Receptor / Q000032:analysis
D019380:Anti-HIV Agents; D019014:fas Receptor; D051997:ADP-ribosyl Cyclase 1