title: Elevated CD8 T-cell counts and virological failure in HIV-infected patients after combination antiretroviral therapy.
abstract: Elevated CD8 counts with combination antiretroviral therapy (cART) initiation may be an early warning indicator for future treatment failure. Thus, we investigated whether elevated CD8 counts were associated with virological failure (VF) in the first 4 years of cART in Asian HIV-infected patients in a multicenter regional cohort.We included patients from the TREAT Asia HIV Observational Database (TAHOD). Patients were included in the analysis if they started cART between 1996 and 2013 with at least one CD8 measurement within 6 months prior to cART initiation and at least one CD8 and viral load (VL) measurement beyond 6 months after starting cART. We defined VF as VL ≥400 copies/mL after 6 months on cART. Elevated CD8 was defined as CD8 ≥1200 cells/μL. Time to VF was modeled using Cox regression analysis, stratified by site.In total, 2475 patients from 19 sites were included in this analysis, of whom 665 (27%) experienced VF in the first 4 years of cART. The overall rate of VF was 12.95 per 100 person-years. In the multivariate model, the most recent elevated CD8 was significantly associated with a greater hazard of VF (HR = 1.35, 95% CI 1.14-1.61; P = 0.001). However, the sensitivity analysis showed that time-lagged CD8 measured at least 6 months prior to our virological endpoint was not statistically significant (P = 0.420).This study indicates that the relationship between the most recent CD8 count and VF was possibly due to the CD8 cells reacting to the increase in VL rather than causing the VL increase itself. However, CD8 levels may be a useful indicator for VF in HIV-infected patients after starting cART.
authors: Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea The Kirby Institute, UNSW Australia, Sydney, Australia Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore, Singapore Working Group on AIDS Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia Infectious Diseases Department, Bach Mai Hospital, Hanoi, Vietnam Queen Elizabeth Hospital and Integrated Treatment Centre, Hong Kong, China Hospital Sungai Buloh, Sungai Buloh, Malaysia HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand Taipei Veterans General Hospital, Taipei, Taiwan University Malaya Medical Centre, Kuala Lumpur, Malaysia Beijing Ditan Hospital, Capital Medical University, Beijing, China Institute of Infectious Diseases, Pune, India Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand National Center for Global Health and Medicine, Tokyo, Japan Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India National Hospital for Tropical Diseases, Hanoi, Vietnam Research Institute for Tropical Medicine, Manila, Philippines Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Faculty of Medicine, Udayana University and Sanglah Hospital, Bali, Indonesia TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand.
authors: Nam Su
authors: NS
authors: Ku
authors: Awachana
authors: A
authors: Jiamsakul
authors: Oon Tek
authors: OT
authors: Ng
authors: Evy
authors: E
authors: Yunihastuti
authors: Do Duy
authors: DD
authors: Cuong
authors: Man Po
authors: MP
authors: Lee
authors: Benedict Lim Heng
authors: BLH
authors: Sim
authors: Praphan
authors: P
authors: Phanuphak
authors: Wing-Wai
authors: WW
authors: Wong
authors: Adeeba
authors: A
authors: Kamarulzaman
authors: Fujie
authors: F
authors: Zhang
authors: Sanjay
authors: S
authors: Pujari
authors: Romanee
authors: R
authors: Chaiwarith
authors: Shinichi
authors: S
authors: Oka
authors: Mahiran
authors: M
authors: Mustafa
authors: Nagalingeswaran
authors: N
authors: Kumarasamy
authors: Kinh
authors: K
authors: Van Nguyen
authors: Rossana
authors: R
authors: Ditangco
authors: Sasisopin
authors: S
authors: Kiertiburanakul
authors: Tuti Parwati
authors: TP
authors: Merati
authors: Nicolas
authors: N
authors: Durier
authors: Jun Yong
authors: JY
authors: Choi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018414:CD8-Positive T-Lymphocytes / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents