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HIV Med. 2017 Jan;18(1):33-44. doi: 10.1111/hiv.12389. Epub 2016 Sep 14.

Reference curves for CD4 T-cell count response to combination antiretroviral therapy in HIV-1-infected treatment-naïve patients.

Author information

1
CIC 1401, CHU de Bordeaux, Bordeaux, France.
2
INSERM U1219 - Centre Inserm Bordeaux Population Health, Université de Bordeaux, Bordeaux, France.
3
ISPED, Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, Bordeaux, France.
4
Research Department of Infection & Population Health, UCL, London, UK.
5
Stichting HIV Monitoring, Amsterdam, The Netherlands.
6
Department of Hygiene, Epidemiology & Medical Statistics, Athens University Medical School, Athens, Greece.
7
Montpellier University, Montpellier, France.
8
Infectious Diseases Unit, Department of Health Sciences, San Paolo University Hospital, Milan, Italy.
9
INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), UPMC Univ Paris 06, Sorbonne Universités, F-75013, Paris, France.
10
Hospital General of Castellon, Castellón, Spain.
11
Infectious Diseases Service. Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
12
Division of Infectious Diseases and Hospital Epidemiology, Department of Clinical Research, University Hospital of Basel, Basel, Switzerland.
13
Department of Dermatology, Venerology - Center for Sexual Health and Medicine, Ruhr-Universität Bochum, Bochum, Germany.
14
Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain.
15
Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France.
16
Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.
17
Department of Infectious Diseases, St Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
18
Department of Internal Medicine, University of Cologne and German Centre for Infection Research (DZIF), Cologne, Germany.
19
Medical University Innsbruck, Innsbruck, Austria.
20
APHP, Unité Fonctionnelle de Thérapeutique en Immuno-Infectiologie, Centre Hospitalier Universitaire Hôtel Dieu, Paris, France.
21
Faculté de Médecine Site Necker, Sorbonne Paris Cité, Université Paris Descartes, EA 7327, Paris, France.
22
Vall d'Hebrón Institut de Recerca (VHIR), Barcelona, Spain.
23
Universitat Autònoma de Barcelona, Barcelona, Spain.
24
CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
25
Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands.
26
Department of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands.
27
CHU de Bordeaux, Pole de Sante Publique, Service d'Information Medicale, F-33000, Bordeaux, France.
28
INSERM, U1018, Epidemiology of HIV, Reproduction, Paediatrics, CESP; University Paris-Sud, Paris, France.
29
Department of Public Health and Epidemiology, Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, Paris, France.
30
Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
31
Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, University "Magna Graecia", Catanzaro, Italy.

Abstract

OBJECTIVES:

The aim of this work was to provide a reference for the CD4 T-cell count response in the early months after the initiation of combination antiretroviral therapy (cART) in HIV-1-infected patients.

METHODS:

All patients in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) cohort who were aged ≥ 18 years and started cART for the first time between 1 January 2005 and 1 January 2010 and who had at least one available measurement of CD4 count and a viral load ≤ 50 HIV-1 RNA copies/mL at 6 months (± 3 months) after cART initiation were included in the study. Unadjusted and adjusted references curves and predictions were obtained using quantile regressions.

RESULTS:

A total of 28 992 patients were included in the study. The median CD4 T-cell count at treatment initiation was 249 [interquartile range (IQR) 150, 336] cells/μL. The median observed CD4 counts at 6, 9 and 12 months were 382 (IQR 256, 515), 402 (IQR 274, 543) and 420 (IQR 293, 565) cells/μL. The two main factors explaining the variation of CD4 count at 6 months were AIDS stage and CD4 count at cART initiation. A CD4 count increase of ≥ 100 cells/mL is generally required in order that patients stay 'on track' (i.e. with a CD4 count at the same percentile as when they started), with slightly higher gains required for those starting with CD4 counts in the higher percentiles. Individual predictions adjusted for factors influencing CD4 count were more precise.

CONCLUSIONS:

Reference curves aid the evaluation of the immune response early after antiretroviral therapy initiation that leads to viral control.

KEYWORDS:

CD4 response; HIV monitoring; antiretroviral treatment monitoring; longitudinal data

PMID:
27625009
DOI:
10.1111/hiv.12389
[Indexed for MEDLINE]
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