title: Failure to achieve immunological recovery in HIV-infected patients with clinical and virological success after 10 years of combined ART: role of treatment course.
abstract: We assessed factors, including treatment course, associated with failure to obtain a 10 year immunological response after starting first-generation PI-containing combined ART (cART).
  
  
  
  In the prospective COPILOTE cohort of HIV-infected patients started on a first-generation PI-containing regimen in 1997-99, the impact of cART history on the failure to achieve immunological response measured at 10 years was assessed by multivariate logistic regression models in the 399 patients with clinical and virological success of cART.
  
  
  
  Failure of CD4 response (CD4 >500/mm3) was associated with age ≥40 years at baseline (P < 0.001), CD4 cell counts ≤500/mm3at month 4 (P = 0.016) or month 12 (P < 0.001) and ≥3 months of cART interruption (P = 0.016). Factors associated with failure to achieve complete immunological response (CD4 >500/mm3and CD4:CD8 ratio >1) were CD4:CD8 ratio ≤0.8 at month 8 (P < 0.001) or month 12 (P < 0.001), ≥3 months of cumulative cART interruption (P = 0.011), ≥3 antiretroviral regimens (P = 0.009) and ≤4 treatment lines (P = 0.015). Baseline CD4 and CD4:CD8 ratio were not predictors of the 10 year immunological outcomes.
  
  
  
  In this therapeutic cohort of patients starting first-generation PI-containing cART in 1997-99, poor initial immunological response had a negative impact on 10 year CD4 and CD4 plus CD4:CD8 ratio response, despite prolonged virological success. Lack of treatment interruption may improve long-term immunological outcome in HIV infection.
authors.affiliation: University of Nantes, Nantes, France francois.raffi@wanadoo.fr.
authors.forename: François
authors.initials: F
authors.lastname: Raffi
authors.affiliation: University of Montpellier, Institut de recherche sur le développement, UMI 233, Montpellier, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
authors.affiliation: INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, University of Bordeaux, Bordeaux, France.
authors.forename: Alex
authors.initials: A
authors.lastname: Assuied
authors.affiliation: Université Diderot, Sorbonne Paris Cité, and INSERM, UMR 1137, Paris, France.
authors.forename: Sofiane
authors.initials: S
authors.lastname: Habak
authors.affiliation: INSERM, and Aix Marseille Université, UMR912 (SESSTIM), IRD, Marseille, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.affiliation: University of Bordeaux, Bordeaux, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Cazanave
authors.affiliation: University of Nantes, Nantes, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Billaud
authors.affiliation: University of Nice, Nice, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Dellamonica
authors.affiliation: Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM 1111, Lyon, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Ferry
authors.affiliation: INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, University of Bordeaux, Bordeaux, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Fagard
authors.affiliation: Université Diderot, Sorbonne Paris Cité, and INSERM, UMR 1137, Paris, France.|Assistance Publique-Hôpitaux de Paris, Unité de Coordination du Risque Épidémique et Biologique, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Leport
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017211:Treatment Failure
chemical_list: D044966:Anti-Retroviral Agents