title: Factors predicting discordant virological and immunological responses to antiretroviral therapy in HIV-1 clade C infected Zulu/Xhosa in South Africa.
abstract: Factors predicting suboptimal CD4 cell recovery have been studied in HIV clade-B infected US and European populations. It is, however, uncertain to what extent these results are applicable to HIV clade-C infected African populations. Multivariate analysis using logistic regression and longitudinal analyses using mixed models were employed to assess the impact of age, gender, baseline CD4 cell count, hemoglobin, body mass index (BMI), tuberculosis and other opportunistic co-infections, and frequencies of regimen change on CD4 cell recovery at 12 and 30 months and on overtime change in CD4 cells among 442 virologically suppressed South Africans. Despite adequate virological response 37% (95% CI:32%-42%) and 83% (95% CI:79%-86%) of patients on antiretroviral therapy failed to restore CD4 cell counts ≥ 200 cells/mm(3) after 12 and ≥ 500 cells/mm(3) after 30 months, respectively, in this South African cohort. Critical risk factors for inadequate recovery were older age (p = 0.001) and nadir CD4 cell count at ART initiation (p<0.0001), while concurrent TB co-infection, BMI, baseline hemoglobin, gender and antiretroviral regimen were not significant risk factors. These data suggest that greater efforts are needed to identify and treat HAART-eligible patients prior to severe CD4 cell decline or achievement of advanced age.
authors.affiliation: Ragon Institute of MGH, MIT and Harvard, Boston, Massachusetts, United States of America. bjulg@partners.org
authors.forename: Boris
authors.initials: B
authors.lastname: Julg
authors.forename: Danielle
authors.initials: D
authors.lastname: Poole
authors.forename: Musie
authors.initials: M
authors.lastname: Ghebremichael
authors.forename: Carmen
authors.initials: C
authors.lastname: Castilla
authors.forename: Marcus
authors.initials: M
authors.lastname: Altfeld
authors.forename: Henry
authors.initials: H
authors.lastname: Sunpath
authors.forename: Richard A
authors.initials: RA
authors.lastname: Murphy
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Walker
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D018791:CD4 Lymphocyte Count; D005006:Ethnicity; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013019:South Africa; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents