title: CD41 T cell recovery during suppression of HIV  replication: an international comparison of the  immunological efficacy of antiretroviral therapy  in North America, Asia and Africa.
abstract: BACKGROUND
  Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally.
  
  
  METHODS
  We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitorbased regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level <500/ml in the first year of therapy and observed CD4 changes during HIV RNA suppression. We used a piecewise linear regression to estimate the influence of region of residence on CD4 recovery, adjusting for socio-demographic and clinical characteristics. We observed 28 217 patients from 105 cohorts over 37 825 person-years.
  
  
  RESULTS
  After adjustment, patients from East Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/ml was 529/ml [95% confidence interval (CI): 517–541] in North America, 494/ml (95% CI: 429–559) in West Africa, 515/ml (95% CI: 508–522) in Southern Africa, 503/ml (95% CI: 478–528) in Asia and 437/ml (95% CI: 425–449) in East Africa.
  
  
  CONCLUSIONS
  CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional level.
authors: Elvin H
authors: EH
authors: Geng
authors: Torsten B
authors: TB
authors: Neilands
authors: Rodolphe
authors: R
authors: Thièbaut
authors: Mwebesa Bosco
authors: MB
authors: Bwana
authors: Denis
authors: D
authors: Nash
authors: Richard D
authors: RD
authors: Moore
authors: Robin
authors: R
authors: Wood
authors: Djimon Marcel
authors: DM
authors: Zannou
authors: Keri N
authors: KN
authors: Althoff
authors: Poh Lian
authors: PL
authors: Lim
authors: Jean B
authors: JB
authors: Nachega
authors: Philippa J
authors: PJ
authors: Easterbrook
authors: Andrew
authors: A
authors: Kambugu
authors: Francesca
authors: F
authors: Little
authors: Gertrude
authors: G
authors: Nakigozi
authors: Damalie
authors: D
authors: Nakanjako
authors: Valerian
authors: V
authors: Kiggundu
authors: Patrick Chung
authors: PC
authors: Ki Li
authors: David R
authors: DR
authors: Bangsberg
authors: Matthew P
authors: MP
authors: Fox
authors: HansW
authors: H
authors: Prozesky
authors: Peter W
authors: PW
authors: Hunt
authors: Mary-Ann
authors: MA
authors: Davies
authors: Steven J
authors: SJ
authors: Reynolds
authors: Matthias
authors: M
authors: Egger
authors: Constantin T
authors: CT
authors: Yiannoutsos
authors: Eric V
authors: EV
authors: Vittinghoff
authors: Steven G
authors: SG
authors: Deeks
authors: Jeffrey N
authors: JN
authors: Martin
mesh_terms: D000328:Adult; D000349:Africa / Q000453:epidemiology; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000276:immunology* / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D048588:Benzoxazines / Q000276:immunology / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data*; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D008297:Male; D019829:Nevirapine / Q000276:immunology / Q000627:therapeutic use; D009656:North America / Q000453:epidemiology; D012367:RNA, Viral; D014779:Virus Replication / Q000187:drug effects / Q000276:immunology
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D012367:RNA, Viral; D019829:Nevirapine; C098320:efavirenz