title: Predictors of CD4(+) T-cell counts of HIV type 1-infected persons after virologic failure of all 3 original antiretroviral drug classes.
abstract: BACKGROUND
  Low CD4(+) T-cell counts are the main factor leading to clinical progression in human immunodeficiency virus type 1 (HIV-1) infection. We aimed to investigate factors affecting CD4(+) T-cell counts after triple-class virological failure.
  
  
  METHODS
  We included individuals from the COHERE database who started antiretroviral therapy from 1998 onward and who experienced triple-class virological failure. CD4(+) T-cell counts obtained after triple-class virologic failure were analyzed using generalized estimating equations.
  
  
  RESULTS
  The analyses included 2424 individuals with a total of 23 922 CD4(+) T-cell count measurements. In adjusted models (excluding current viral load and year), CD4(+) T-cell counts were higher with regimens that included boosted protease inhibitors (increase, 22 cells/µL [95% confidence interval {CI}, 3.9-41]; P = .017) or drugs from the new classes (increase, 39 cells/µL [95% CI, 15-62]; P = .001), compared with nonnucleoside reverse-transcriptase inhibitor-based regimens. These associations disappeared when current viral load and/or calendar year were included. Compared with viral levels of <2.5 log(10) copies/mL, levels of 2.5-3.5, 3.5-4.5, 4.5-5.5, and >5.5 log(10) copies/mL were associated with CD4(+) T-cell count decreases of 51, 84, 137, and 186 cells/µL, respectively (P < .001).
  
  
  CONCLUSIONS
  The approximately linear inverse relationship between log(10) viral load and CD4(+) T-cell count indicates that there are likely immunologic benefits from lowering viral load even by modest amounts that do not lead to undetectable viral loads. This is important for patients with low CD4(+) T-cell counts and few drug options.
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Bruno
authors.initials: B
authors.lastname: Ledergerber
authors.forename: Carlo
authors.initials: C
authors.lastname: Torti
authors.forename: Ard
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authors.lastname: van Sighem
authors.forename: Daniel
authors.initials: D
authors.lastname: Podzamczer
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Maria
authors.initials: M
authors.lastname: Dorrucci
authors.forename: Bernard
authors.initials: B
authors.lastname: Masquelier
authors.forename: Andrea
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authors.lastname: de Luca
authors.forename: Klaus
authors.initials: K
authors.lastname: Jansen
authors.forename: Stephane
authors.initials: S
authors.lastname: De Wit
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
authors.forename: Gerd
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: Giota
authors.initials: G
authors.lastname: Touloumi
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
authors.forename: Cristoph
authors.initials: C
authors.lastname: Stephan
authors.forename: Federico
authors.initials: F
authors.lastname: García
authors.forename: Robert
authors.initials: R
authors.lastname: Zangerle
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
authors.forename: Santiago
authors.initials: S
authors.lastname: Perez-Hoyos
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.forename: Jade
authors.initials: J
authors.lastname: Ghosn
authors.forename: Céline
authors.initials: C
authors.lastname: Fabre-Colin
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaer
authors.forename: Genevieve
authors.initials: G
authors.lastname: Chêne
authors.forename: Jesper
authors.initials: J
authors.lastname: Grarup
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lodwick
authors.forename: Carlo
authors.initials: C
authors.lastname: Torti
authors.forename: Maria
authors.initials: M
authors.lastname: Dorrucci
authors.forename: Huldrych F
authors.initials: HF
authors.lastname: Günthard
authors.forename: Claudia
authors.initials: C
authors.lastname: Michalik
authors.forename: George
authors.initials: G
authors.lastname: Chrysos
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents