Early Initiation Rather Than Prolonged Duration of Antiretroviral Therapy in HIV Infection Contributes to the Normalization of CD8 T-Cell Counts.

Autor:	Cao W; Research Institute of the McGill University Health Centre.; Chronic Viral Illness Service.; Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China., Mehraj V; Research Institute of the McGill University Health Centre.; Chronic Viral Illness Service., Trottier B; Clinique Médicale l'Actuel., Baril JG; Clinique Médicale Quartier Latin., Leblanc R; Chronic Viral Illness Service.; Clinique Médicale OPUS., Lebouche B; Chronic Viral Illness Service., Cox J; Chronic Viral Illness Service., Tremblay C; CHUM Research Centre.; Department of Microbiology and Immunology, University of Montreal, Quebec, Canada., Lu W; Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China., Singer J; School of Population and Public Health, University of British Columbia, Vancouver, Canada., Li T; Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China., Routy JP; Research Institute of the McGill University Health Centre.; Chronic Viral Illness Service.; Division of Hematology, McGill University Health Centre., Vézina S, Charest L, Milne M, Huchet E, Lavoie S, Friedman J, Duchastel M, Villielm F, Côté P, Potter M, Lessard B, Charron MA, Dufresne S, Turgeon ME, Rouleau D, Labrecque L, Fortin C, de Pokomandy A, Hal-Gagné V, Munoz M, Deligne B, Martel-Laferrière V, Gilmore N, Fletcher M, Szabo J
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2016 Jan 15; Vol. 62 (2), pp. 250-257. Date of Electronic Publication: 2015 Sep 08.
DOI:	10.1093/cid/civ809
Abstrakt:	Background: CD8 T-cell counts remain elevated in human immunodeficiency virus (HIV) infection even after long-term antiretroviral therapy (ART), which is associated with an increased risk of non-AIDS-related events. We assessed the impact of ART initiation in early versus chronic HIV infection on trajectories of CD8 cell counts over time. Methods: Of 280 individuals enrolled during primary HIV infection (PHI), 251 were followed up for 24 months; 84 started ART before 6 months of infection (eART), 49 started between 6 and 24 months, and 118 remained untreated. Plasma HIV viral load (VL), CD4 and CD8 cell counts were assessed at each study visit. CD8 counts were also examined in 182 age-matched HIV-infected individuals who started ART during chronic infection and maintained undetectable plasma VL for ≥5 years. Results: At PHI baseline, higher CD8 cell counts were associated with more recent infection (P = .02), higher CD4 cell counts (P < .001), and higher VL (P < .001). The CD8 count in the eART group decreased from 797 to 588 cells/µL over 24 months (P < .001), to a level lower than that in untreated PHI (834 cells/µL; P = .004) or in long-term-treated patients with chronic HIV infection (743 cells/µL; P = .047). More prominent CD4 T-cell recovery was observed in the eART group than in the delayed ART group. Conclusions: ART initiated in early HIV infection is associated with improved resolution of CD8 T-cell elevation compared with long-term ART initiated in chronic infection. Early ART may help reduce the risk of non-AIDS-related events by alleviating this elevation. (© The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.)
Databáze:	MEDLINE
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