CD41 T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa.

TitleCD41 T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa.
Publication TypeJournal Article
Year of Publication2015
AuthorsGeng, EH, Neilands, TB, Thièbaut, R, Bwana, MBosco, Nash, D, Moore, RD, Wood, R, Zannou, DMarcel, Althoff, KN, Lim, PLian, Nachega, JB, Easterbrook, PJ, Kambugu, A, Little, F, Nakigozi, G, Nakanjako, D, Kiggundu, V, Li, PChung Ki, Bangsberg, DR, Fox, MP, Prozesky, HW, Hunt, PW, Davies, M-A, Reynolds, SJ, Egger, M, Yiannoutsos, CT, Vittinghoff, EV, Deeks, SG, Martin, JN
JournalInt J Epidemiol
Volume44
Issue1
Pagination251-63
Date Published2015 Feb
ISSN1464-3685
KeywordsAdult, Africa, Anti-HIV Agents, Asia, Benzoxazines, CD4 Lymphocyte Count, Drug Therapy, Combination, Female, HIV Infections, Humans, Male, Nevirapine, North America, RNA, Viral, Virus Replication
Abstract

BACKGROUND: Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally.METHODS: We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitorbased regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level <500/ml in the first year of therapy and observed CD4 changes during HIV RNA suppression. We used a piecewise linear regression to estimate the influence of region of residence on CD4 recovery, adjusting for socio-demographic and clinical characteristics. We observed 28 217 patients from 105 cohorts over 37 825 person-years.RESULTS: After adjustment, patients from East Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/ml was 529/ml [95% confidence interval (CI): 517–541] in North America, 494/ml (95% CI: 429–559) in West Africa, 515/ml (95% CI: 508–522) in Southern Africa, 503/ml (95% CI: 478–528) in Asia and 437/ml (95% CI: 425–449) in East Africa.CONCLUSIONS: CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional level.

Alternate JournalInt J Epidemiol
PubMed ID25859596
PubMed Central IDPMC4339766
Grant ListK23AI084544 / AI / NIAID NIH HHS / United States
P30 AI027763 / AI / NIAID NIH HHS / United States
P30 AI027763 / AI / NIAID NIH HHS / United States
P30 AI050410 / AI / NIAID NIH HHS / United States
P30 MH062246 / MH / NIMH NIH HHS / United States
R01 MH054907 / MH / NIMH NIH HHS / United States
R25 TW009343 / TW / FIC NIH HHS / United States
U01 AI069907 / AI / NIAID NIH HHS / United States
U01 AI069911 / AI / NIAID NIH HHS / United States
U01 AI069918 / AI / NIAID NIH HHS / United States
U01 AI069919 / AI / NIAID NIH HHS / United States
U01 AI069924 / AI / NIAID NIH HHS / United States
U01AI069911 / AI / NIAID NIH HHS / United States
/ / Intramural NIH HHS / United States