title: Immunologic response in treatment-naïve HIV-2-infected patients: the IeDEA West Africa cohort.
abstract: BACKGROUND
  Response to antiretroviral therapy (ART) among individuals infected with HIV-2 is poorly described. We compared the immunological response among patients treated with three nucleoside reverse-transcriptase inhibitors (NRTIs) to boosted protease inhibitor (PI) and unboosted PI-based regimens in West Africa.
  
  
  METHODS
  This prospective cohort study enrolled treatment-naïve HIV-2-infected patients within the International Epidemiological Databases to Evaluate AIDS collaboration in West Africa. We used mixed models to compare the CD4 count response to treatment over 12 months between regimens.
  
  
  RESULTS
  Of 422 HIV-2-infected patients, 285 (67.5%) were treated with a boosted PI-based regimen, 104 (24.6%) with an unboosted PI-based regimen and 33 (7.8%) with three NRTIs. Treatment groups were comparable with regard to gender (54.5% female) and median age at ART initiation (45.3 years; interquartile range 38.3 to 51.8). Treatment groups differed by clinical stage (21.2%, 16.8% and 17.3% at CDC Stage C or World Health Organization Stage IV for the triple NRTI, boosted PI and unboosted PI groups, respectively, p=0.02), median length of follow-up (12.9, 17.7 and 44.0 months for the triple NRTI, the boosted PI and the unboosted PI groups, respectively, p<0.001) and baseline median CD4 count (192, 173 and 129 cells/µl in the triple NRTI, the boosted PI and the unboosted PI-based regimen groups, respectively, p=0.003). CD4 count recovery at 12 months was higher for patients treated with boosted PI-based regimens than those treated with three NRTIs or with unboosted PI-based regimens (191 cells/µl, 95% CI 142 to 241; 110 cells/µl, 95% CI 29 to 192; 133 cells/µl, 95% CI 80 to 186, respectively, p=0.004).
  
  
  CONCLUSIONS
  In this observational study using African data, boosted PI-containing regimens had better immunological response compared to triple NRTI combinations and unboosted PI-based regimens at 12 months. A randomized clinical trial is still required to determine the best initial regimen for treating HIV-2 infected patients.
authors: University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.|INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France; eric.balestre@isped.u-bordeaux2.fr.
authors: Eric
authors: E
authors: Balestre
authors: University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.|INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.|Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire; didier.ekouevi@gmail.com.
authors: Didier Koumavi
authors: DK
authors: Ekouevi
authors: University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.|INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.|Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.
authors: Boris
authors: B
authors: Tchounga
authors: Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.|Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.|Département de Dermatologie-Infectiologie de l'Unité de Formation et de Recherche des Sciences médicales, Université Félix Houphouet Boigny, Abidjan, Côte d'Ivoire.
authors: Serge Paul
authors: SP
authors: Eholie
authors: Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.|Centre de Prise en charge de Recherche et de Formation, Hôpital Yopougon Attié, Abidjan, Côte d'Ivoire.
authors: Eugène
authors: E
authors: Messou
authors: Institut Supérieur des Sciences de la santé, Université Polytechnique de Bobo-Dioulasso, Nasso, Burkina Faso.
authors: Adrien
authors: A
authors: Sawadogo
authors: University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.|INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.
authors: Rodolphe
authors: R
authors: Thiébaut
authors: School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom.
authors: Margaret T
authors: MT
authors: May
authors: School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom.
authors: Jonathan Ac
authors: JA
authors: Sterne
authors: University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.|INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France.
authors: François
authors: F
authors: Dabis
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D015498:HIV-2; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: HIV-2; West Africa; antiretroviral treatment; immunological response; linear mixed models