title: First-year lymphocyte T CD4+ response to antiretroviral therapy according to the HIV type in the IeDEA West Africa collaboration.
abstract: 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.
authors.affiliation: INSERM U897, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Drylewicz
authors.forename: Serge
authors.initials: S
authors.lastname: Eholie
authors.forename: Moussa
authors.initials: M
authors.lastname: Maiga
authors.forename: Djimon Marcel
authors.initials: DM
authors.lastname: Zannou
authors.forename: Papa Salif
authors.initials: PS
authors.lastname: Sow
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.forename: Kevin
authors.initials: K
authors.lastname: Peterson
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bissagnene
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thiébaut
mesh_terms: 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
chemical_list: D017320:HIV Protease Inhibitors; D012367:RNA, Viral
references.citation: J Hum Virol. 1998 Nov-Dec;1(7):457-68
references.pmid: 10195267
references.citation: J Virol. 2007 May;81(10):5325-30
references.pmid: 17329334
references.citation: AIDS. 2008 Nov 12;22(17):2291-302
references.pmid: 18981768
references.citation: N Engl J Med. 2000 Jun 8;342(23):1758-60
references.pmid: 10858105
references.citation: AIDS. 2009 Jun 1;23(9):1171-3
references.pmid: 19349850
references.citation: Stat Med. 2005 Jan 15;24(1):65-82
references.pmid: 15523706
references.citation: J Clin Microbiol. 2009 Jul;47(7):2200-8
references.pmid: 19420165
references.citation: Clin Infect Dis. 2009 Feb 15;48(4):476-83
references.pmid: 19143530
references.citation: AIDS. 2008 Apr 23;22(7):873-82
references.pmid: 18427206
references.citation: J Acquir Immune Defic Syndr. 2007 Mar 1;44(3):262-7
references.pmid: 17146376
references.citation: AIDS. 2007 Jan 30;21(3):317-24
references.pmid: 17255738
references.citation: J Clin Virol. 2009 May;45(1):72-5
references.pmid: 19375979
references.citation: AIDS. 2009 Jan 28;23(3):426-8
references.pmid: 19114866
references.citation: J Clin Microbiol. 2004 Sep;42(9):4147-53
references.pmid: 15365003
references.citation: AIDS. 2006 May 12;20(8):1181-9
references.pmid: 16691070
references.citation: AIDS. 2008 Mar 30;22(6):791-2
references.pmid: 18356612
references.citation: Int J Epidemiol. 2006 Oct;35(5):1329-30
references.pmid: 16847021
references.citation: Clin Infect Dis. 2009 Jun 15;48(12):1790-3
references.pmid: 19438401
references.citation: Clin Infect Dis. 2009 Apr 15;48(8):1166-7
references.pmid: 19292644
references.citation: Chem Biol Drug Des. 2008 Apr;71(4):298-305
references.pmid: 18312292
references.citation: AIDS. 2006 Jun 26;20(10):1455-8
references.pmid: 16791023
references.citation: Int J Epidemiol. 2006 Oct;35(5):1322-8
references.pmid: 16543363
references.citation: QJM. 2008 Oct;101(10):821-4
references.pmid: 18689428
references.citation: JAMA. 2006 Aug 16;296(7):782-93
references.pmid: 16905784
references.citation: AIDS. 2008 Jul 11;22(11):1305-12
references.pmid: 18580610
references.citation: AIDS. 2003 Jul;17 Suppl 3:S79-86
references.pmid: 14565613
references.citation: Proc Natl Acad Sci U S A. 2002 Oct 29;99(22):14410-5
references.pmid: 12386343
references.citation: PLoS Med. 2009 Apr 28;6(4):e1000066
references.pmid: 19399157
references.citation: AIDS. 1994 Nov;8(11):1617-20
references.pmid: 7848600
references.citation: AIDS. 2008 Oct 18;22(16):2069-72; discussion 2073-4
references.pmid: 18832869
references.citation: AIDS. 2008 Feb 19;22(4):457-68
references.pmid: 18301058
references.citation: Nat Med. 1998 Feb;4(2):208-14
references.pmid: 9461195
references.citation: J Antimicrob Chemother. 2009 Sep;64(3):667-9
references.pmid: 19549668
references.citation: AIDS Care. 2008 May;20(5):582-7
references.pmid: 18484329
references.citation: J Infect Dis. 2009 May 1;199(9):1323-6
references.pmid: 19358668
references.citation: Antivir Ther. 2004 Feb;9(1):57-65
references.pmid: 15040537
references.citation: J Acquir Immune Defic Syndr. 2008 Aug 1;48(4):476-84
references.pmid: 18614917
references.citation: AIDS. 2006 Feb 14;20(3):459-62
references.pmid: 16439883
references.citation: J Med Virol. 2004 Oct;74(2):197-201
references.pmid: 15332266