title: Mean CD4 cell count changes in patients failing a first-line antiretroviral therapy in resource-limited settings.
abstract: BACKGROUND
  Changes in CD4 cell counts are poorly documented in individuals with low or moderate-level viremia while on antiretroviral treatment (ART) in resource-limited settings. We assessed the impact of on-going HIV-RNA replication on CD4 cell count slopes in patients treated with a first-line combination ART.
  
  
  METHODS
  Naïve patients on a first-line ART regimen with at least two measures of HIV-RNA available after ART initiation were included in the study. The relationships between mean CD4 cell count change and HIV-RNA at 6 and 12 months after ART initiation (M6 and M12) were assessed by linear mixed models adjusted for gender, age, clinical stage and year of starting ART.
  
  
  RESULTS
  3,338 patients were included (14 cohorts, 64% female) and the group had the following characteristics: a median follow-up time of 1.6 years, a median age of 34 years, and a median CD4 cell count at ART initiation of 107 cells/μL. All patients with suppressed HIV-RNA at M12 had a continuous increase in CD4 cell count up to 18 months after treatment initiation. By contrast, any degree of HIV-RNA replication both at M6 and M12 was associated with a flat or a decreasing CD4 cell count slope. Multivariable analysis using HIV-RNA thresholds of 10,000 and 5,000 copies confirmed the significant effect of HIV-RNA on CD4 cell counts both at M6 and M12.
  
  
  CONCLUSIONS
  In routinely monitored patients on an NNRTI-based first-line ART, on-going low-level HIV-RNA replication was associated with a poor immune outcome in patients who had detectable levels of the virus after one year of ART.
authors: HIV Unit, Geneva University Hospital, Geneva, Switzerland. acalmy@gmail.com
authors: Alexandra
authors: A
authors: Calmy
authors: Eric
authors: E
authors: Balestre
authors: Fabrice
authors: F
authors: Bonnet
authors: Andrew
authors: A
authors: Boulle
authors: Eduardo
authors: E
authors: Sprinz
authors: Robin
authors: R
authors: Wood
authors: Eric
authors: E
authors: Delaporte
authors: Eugène
authors: E
authors: Messou
authors: James
authors: J
authors: McIntyre
authors: Kamal Marhoum
authors: KM
authors: El Filali
authors: Mauro
authors: M
authors: Schechter
authors: N
authors: N
authors: Kumarasamy
authors: David
authors: D
authors: Bangsberg
authors: Patrick
authors: P
authors: McPhail
authors: Stefaan
authors: S
authors: Van Der Borght
authors: Carlos
authors: C
authors: Zala
authors: Matthias
authors: M
authors: Egger
authors: Rodolphe
authors: R
authors: Thiébaut
authors: François
authors: F
authors: Dabis
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000235:genetics
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral