Failure to achieve immunological recovery in HIV-infected patients with clinical and virological success after 10 years of combined ART: role of treatment course.

Autor:	Raffi F; University of Nantes, Nantes, France francois.raffi@wanadoo.fr., Le Moing V; University of Montpellier, Institut de recherche sur le développement, UMI 233, Montpellier, France., Assuied A; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, University of Bordeaux, Bordeaux, France., Habak S; Université Diderot, Sorbonne Paris Cité, and INSERM, UMR 1137, Paris, France., Spire B; INSERM, and Aix Marseille Université, UMR912 (SESSTIM), IRD, Marseille, France., Cazanave C; University of Bordeaux, Bordeaux, France., Billaud E; University of Nantes, Nantes, France., Dellamonica P; University of Nice, Nice, France., Ferry T; Hospices Civils de Lyon, Université Claude Bernard Lyon 1, INSERM 1111, Lyon, France., Fagard C; INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, University of Bordeaux, Bordeaux, France., Leport C; 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.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2017 Jan; Vol. 72 (1), pp. 240-245. Date of Electronic Publication: 2016 Sep 13.
DOI:	10.1093/jac/dkw369
Abstrakt:	Objectives: 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). Patients and Methods: 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. Results: Failure of CD4 response (CD4 >500/mm 3 ) was associated with age ≥40 years at baseline (P < 0.001), CD4 cell counts ≤500/mm 3 at 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/mm 3 and 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. Conclusions: 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. (© The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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