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J Antimicrob Chemother. 2017 Oct 1;72(10):2869-2878. doi: 10.1093/jac/dkx210.

CD4 cell count response to first-line combination ART in HIV-2+ patients compared with HIV-1+ patients: a multinational, multicohort European study.

Author information

1
Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, CIC-EC 1401, F-33000 Bordeaux, France.
2
CHU de Bordeaux, Pôle de santé publique, F-33000 Bordeaux, France.
3
Infectious Diseases Department, Hospital Carlos III, Madrid, Spain.
4
GGD Amsterdam, Amsterdam, The Netherlands and CINIMA, AMC, Amsterdam, The Netherlands.
5
Homerton University Hospital NHS Trust, London, UK.
6
Stichting HIV Monitoring, Amsterdam, The Netherlands.
7
Institute of Medical Virology, Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland.
8
Assistance Publique-Hopitaux de Paris, Hopital Bichat-Claude Bernard, Laboratoire de Virologie, Universite Paris 7, Paris, France.
9
Department of Infectious Diseases, Hospital Carlos III, Sinesio Delgado 10, Madrid 28029, Spain.
10
Inserm U1018, CESP Centre for Research in Epidemiology and Population Health, Epidemiology of HIV and STI Team, Le Kremlin-Bicêtre, France and Univ Paris-Sud, Le Kremlin-Bicêtre, France.
11
Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.
12
Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland.
13
Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Avda. Monforte de Lemos, Madrid 528029, Spain and CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
14
Istituto Superiore di Sanità, Rome, Italy.
15
Hospitais da Universidade de Coimbra, Departamento de Doenças Infecciosas, Coimbra, Portugal.
16
First Department of Internal Medicine, University of Cologne, Cologne, Germany.
17
Department of Dermatology and Venerology, Innsbruck Medical University, Innsbruck, Austria.
18
HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat Barcelona, Spain.
19
Medical Research Council Clinical Trials Unit, University College London, London, UK.
20
Pathophysiology Department, Laiko General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece.
21
AP-HP Service de Médecine Interne, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
22
Department of Infection and Population Health, University College London Medical School, London NW32PF, UK.
23
Universite Paris Diderot, Sorbonne Paris Cite, UMR 1137, Paris, France and INSERM, UMR 1137, Paris, France.
24
FHI 360, Durham, NC, USA.
25
Clinic of Infectious Diseases, Department of Internal Medicine and Medical Specialties, University of Modena and Reggio Emilia, Modena, Italy.
26
Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.
27
Université catholique de Louvain, IREC, AIDS Reference Laboratory, Brussels, Belgium.
28
Department of Internal Medicine I, Bonn University Hospital, Bonn, Germany.
29
Department of Infectious Diseases, Karolinska Institute, Stockholm, Sweden.
30
Hospital Sierrallana, Torrelavega, Spain.
31
Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, University 'Magna Graecia', Catanzaro, Italy.
32
Clínica Universitária de Doenças Infecciosas e Parasitárias, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal.
33
CHIP, Department of Infectious Diseases and Rheumatology, 2100 Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark.
34
Sorbonne Universités, UPMC Univ. Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France and INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France.
35
INRIA SISTM, F-33405 Talence, France.
36
Assistance Publique-Hôpiteaux de Paris, Hôpital Bichat-Claude Bernard, Paris, France.
37
IAME, INSERM UMR 1137, Paris, France.
38
Université Paris Diderot, Sorbonne Paris Cité, Paris, France.

Abstract

Background:

CD4 cell recovery following first-line combination ART (cART) is poorer in HIV-2+ than in HIV-1+ patients. Only large comparisons may allow adjustments for demographic and pretreatment plasma viral load (pVL).

Methods:

ART-naive HIV+ adults from two European multicohort collaborations, COHERE (HIV-1 alone) and ACHIeV2e (HIV-2 alone), were included, if they started first-line cART (without NNRTIs or fusion inhibitors) between 1997 and 2011. Patients without at least one CD4 cell count before start of cART, without a pretreatment pVL and with missing a priori-defined covariables were excluded. Evolution of CD4 cell count was studied using adjusted linear mixed models.

Results:

We included 185 HIV-2+ and 30321 HIV-1+ patients with median age of 46 years (IQR 36-52) and 37 years (IQR 31-44), respectively. Median observed pretreatment CD4 cell counts/mm3 were 203 (95% CI 100-290) in HIV-2+ patients and 223 (95% CI 100-353) in HIV-1+ patients. Mean observed CD4 cell count changes from start of cART to 12 months were +105 (95% CI 77-134) in HIV-2+ patients and +202 (95% CI 199-205) in HIV-1+ patients, an observed difference of 97 cells/mm3 in 1 year. In adjusted analysis, the mean CD4 cell increase was overall 25 CD4 cells/mm3/year lower (95% CI 5-44; P = 0.0127) in HIV-2+ patients compared with HIV-1+ patients.

Conclusions:

A poorer CD4 cell increase during first-line cART was observed in HIV-2+ patients, even after adjusting for pretreatment pVL and other potential confounders. Our results underline the need to identify more potent therapeutic regimens or strategies against HIV-2.

PMID:
29091198
DOI:
10.1093/jac/dkx210
[Indexed for MEDLINE]
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