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The Pursuing Later Treatment Option II (PLATO II) Project Team of the Collaboration of Observational HIV Epidemiological Research Europe (COHERE), Anne Audelin, Antonella Castagna, Dominique Costagliola, Alessandro Cozzi-Lepri, Andrea De Luca, Stephane De Wit, Frank de Wolf, Maria Dorrucci, Xavier Duval, Gerd Fätkenheuer, Federico García, Jade Ghosn, Huldrych Günthard, Klaus Jansen, Ali Judd, Bruno Ledergerber, Sergio Lo Caputo, Rebecca Lodwick, Bernard Masquelier, Laurence Meyer, Amanda Mocroft, Cristina Mussini, Antoni Noguera-Julian, Niels Obel, Dimitrios Paraskevis, Roger Paredes, Santiago Pérez-Hoyos, Andrew Phillips, Deenan Pillay, Daniel Podzamczer, José T. Ramos, Christoph Stephan, Pat A. Tookey, Carlo Torti, Giota Touloumi, Ard van Sighem, Josiane Warsawski, Robert Zangerle, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Jade Ghosn, Catherine Leport, Frank de Wolf, Peter Reiss, Maria Prins, Heiner Bucher, Caroline Sabin, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Pérez-Hoyos, Antoni Noguera-Julian, Andrea Antinori, Antonella d'Arminio Monforte, Norbert Brockmeyer, José Ramos, Manuel Battegay, Andri Rauch, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M. Miró, Antonella Castagna, Stephane de Wit, Tessa Goetghebuer, Carlo Torti, Ramon Teira, Myriam Garrido, David Haerry, Ian Weller, Jordi Casabona, Dominique Costagliola, Antonella d'Arminio-Monforte, Manuel Battegay, Maria Prins, Frank de Wolf, Jesper Grarup, Genevieve Chene, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, François Dabis, Frank de Wolf, Maria Dorrucci, Matthias Egger, Frederik Engsig, Hansjakob Furrer, Ole Kirk, Olivier Lambotte, Charlotte Lewden, Rebecca Lodwick, Sophie Matheron, Laurence Meyer, Jose Miro, Amanda Mocroft, Niels Obel, Roger Paredes, Andrew Phillips, Massimo Puoti, Joanne Reekie, Caroline Sabin, Alexandra Scherrer, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Viktor von Wyl, Linda Wittkop, Alexandra Scherrer, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Viktor von Wyl, Linda Wittkop, Predictors of CD4+ T-Cell Counts of HIV Type 1–Infected Persons After Virologic Failure of All 3 Original Antiretroviral Drug Classes, The Journal of Infectious Diseases, Volume 207, Issue 5, 1 March 2013, Pages 759–767, https://doi.org/10.1093/infdis/jis752
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Abstract
Background. Low CD4+ T-cell counts are the main factor leading to clinical progression in human immunodeficiency virus type 1 (HIV-1) infection. We aimed to investigate factors affecting CD4+ T-cell counts after triple-class virological failure.
Methods. We included individuals from the COHERE database who started antiretroviral therapy from 1998 onward and who experienced triple-class virological failure. CD4+ T-cell counts obtained after triple-class virologic failure were analyzed using generalized estimating equations.
Results. The analyses included 2424 individuals with a total of 23 922 CD4+ T-cell count measurements. In adjusted models (excluding current viral load and year), CD4+ T-cell counts were higher with regimens that included boosted protease inhibitors (increase, 22 cells/µL [95% confidence interval {CI}, 3.9–41]; P = .017) or drugs from the new classes (increase, 39 cells/µL [95% CI, 15–62]; P = .001), compared with nonnucleoside reverse-transcriptase inhibitor–based regimens. These associations disappeared when current viral load and/or calendar year were included. Compared with viral levels of <2.5 log10 copies/mL, levels of 2.5–3.5, 3.5–4.5, 4.5–5.5, and >5.5 log10 copies/mL were associated with CD4+ T-cell count decreases of 51, 84, 137, and 186 cells/µL, respectively (P < .001).
Conclusions. The approximately linear inverse relationship between log10 viral load and CD4+ T-cell count indicates that there are likely immunologic benefits from lowering viral load even by modest amounts that do not lead to undetectable viral loads. This is important for patients with low CD4+ T-cell counts and few drug options.
