First-year lymphocyte T CD4+ response to antiretroviral therapy according to the HIV type in the IeDEA West Africa collaboration.
OBJECTIVE
To compare the lymphocyte T CD4+ (CD4) response to combinations of antiretroviral therapy (ART) in HIV-1, HIV-2 and dually positive patients in West Africa.


METHODS
Collaboration of 12 prospective cohorts of HIV-infected adults followed in Senegal (2), Gambia (1), Mali (2), Benin (1) and Côte d'Ivoire (6).


METHODS
Nine thousand, four hundred and eighty-two patients infected by HIV-1 only, 270 by HIV-2 only and 321 dually positive, who initiated an ART.


METHODS
CD4 change over a 12-month period.


RESULTS
Observed CD4 cell counts at treatment initiation were similar in the three groups [overall median 155, interquartile range (IQR) 68; 249 cells/microl). In HIV-1 patients, the most common ART regimen was two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI; N = 7714) as well as for dually positive patients (N = 135). HIV-2 patients were most often treated with a protease inhibitor-based regimen (N = 193) but 45 of them were treated with an NNRTI-containing ART. In those treated with a NNRTI-containing regimen, the estimated mean CD4 change between 3 and 12 months was significantly lower in HIV-2 (-41 cells/microl per year) and dually positive patients (+12 cells/microl per year) compared to HIV-1 patients (+69 cells/microl per year, overall P value 0.01). The response in HIV-2 and dually positive patients treated by another regimen (triple NRTIs or protease inhibitor-containing ART) was not significantly different than the response obtained in HIV-1-only patients (all P values >0.30).


CONCLUSIONS
An optimal CD4 response to ART in West Africa requires determining HIV type prior to initiation of antiretroviral drugs. NNRTIs are the mainstay of first-line ART in West Africa but are not adapted to the treatment of HIV-2 and dually positive patients.
Drylewicz
Julia
J
INSERM U897, France.
Eholie
Serge
S
Maiga
Moussa
M
Zannou
Djimon Marcel
DM
Sow
Papa Salif
PS
Ekouevi
Didier K
DK
Peterson
Kevin
K
Bissagnene
Emmanuel
E
Dabis
François
F
Thiébaut
Rodolphe
R
D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1 / Q000276:immunology*; D015498:HIV-2 / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load; D055815:Young Adult
D017320:HIV Protease Inhibitors; D012367:RNA, Viral
J Hum Virol. 1998 Nov-Dec;1(7):457-68
10195267
J Virol. 2007 May;81(10):5325-30
17329334
AIDS. 2008 Nov 12;22(17):2291-302
18981768
N Engl J Med. 2000 Jun 8;342(23):1758-60
10858105
AIDS. 2009 Jun 1;23(9):1171-3
19349850
Stat Med. 2005 Jan 15;24(1):65-82
15523706
J Clin Microbiol. 2009 Jul;47(7):2200-8
19420165
Clin Infect Dis. 2009 Feb 15;48(4):476-83
19143530
AIDS. 2008 Apr 23;22(7):873-82
18427206
J Acquir Immune Defic Syndr. 2007 Mar 1;44(3):262-7
17146376
AIDS. 2007 Jan 30;21(3):317-24
17255738
J Clin Virol. 2009 May;45(1):72-5
19375979
AIDS. 2009 Jan 28;23(3):426-8
19114866
J Clin Microbiol. 2004 Sep;42(9):4147-53
15365003
AIDS. 2006 May 12;20(8):1181-9
16691070
AIDS. 2008 Mar 30;22(6):791-2
18356612
Int J Epidemiol. 2006 Oct;35(5):1329-30
16847021
Clin Infect Dis. 2009 Jun 15;48(12):1790-3
19438401
Clin Infect Dis. 2009 Apr 15;48(8):1166-7
19292644
Chem Biol Drug Des. 2008 Apr;71(4):298-305
18312292
AIDS. 2006 Jun 26;20(10):1455-8
16791023
Int J Epidemiol. 2006 Oct;35(5):1322-8
16543363
QJM. 2008 Oct;101(10):821-4
18689428
JAMA. 2006 Aug 16;296(7):782-93
16905784
AIDS. 2008 Jul 11;22(11):1305-12
18580610
AIDS. 2003 Jul;17 Suppl 3:S79-86
14565613
Proc Natl Acad Sci U S A. 2002 Oct 29;99(22):14410-5
12386343
PLoS Med. 2009 Apr 28;6(4):e1000066
19399157
AIDS. 1994 Nov;8(11):1617-20
7848600
AIDS. 2008 Oct 18;22(16):2069-72; discussion 2073-4
18832869
AIDS. 2008 Feb 19;22(4):457-68
18301058
Nat Med. 1998 Feb;4(2):208-14
9461195
J Antimicrob Chemother. 2009 Sep;64(3):667-9
19549668
AIDS Care. 2008 May;20(5):582-7
18484329
J Infect Dis. 2009 May 1;199(9):1323-6
19358668
Antivir Ther. 2004 Feb;9(1):57-65
15040537
J Acquir Immune Defic Syndr. 2008 Aug 1;48(4):476-84
18614917
AIDS. 2006 Feb 14;20(3):459-62
16439883
J Med Virol. 2004 Oct;74(2):197-201
15332266