Comparison of Early CD4 T-Cell Count in HIV-1 Seroconverters in Côte d'Ivoire and France: The ANRS PRIMO-CI and SEROCO Cohorts

Lewden, Charlotte; Thiébaut, Rodolphe; Boufassa, Faroudy; Coulibaly, Adama; Malateste, Karen; Seng, Rémonie; Toni, Thomas; Inwoley, André; Rouzioux, Christine; Minga, Albert; Anglaret, Xavier; Meyer, Laurence

doi:10.1097/qai.0b013e3181b84260

Cited by 9 publications

(9 citation statements)

References 33 publications

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“…Pretherapy African participants had lower integrated HIV DNA and pVL than non-African participants consistent with the sex difference and other studies [49]. Correlations between pVL, CD4 þ T-cell counts and HIV DNA have been previously described in African cohorts [20,46,50,51], but without associated virological, immunological and clinical outcomes. HIV DNA levels pre-ART in the African participants correlated with pVL and several T-cell activation and exhaustion markers (e.g.…”

Section: Discussionsupporting

confidence: 88%

“…This is not representative of the global burden of disease, given that 70% of PLHIV are in Africa and 50% of prevalent HIV infections are estimated to be due to subtype C [18]. Whereas non-B viral subtypes respond well to ART [19], our current understanding of the reservoir may not translate to African or non-B infected populations, especially as variation in pVL, HIV DNA and CD4 þ T-cell count is linked to ethnicity and geography [20]. There may also be differences between both sex and HIV subtypes relating to replicative fitness, biology of transmission and disease progression [21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Virological remission after antiretroviral therapy interruption in female African HIV seroconverters

Gossez

Martin

Pace

et al. 2019

Aids

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a,h,i , on behalf of the SPARTAC Trial Investigators Introduction: There are few data on the frequency of virological remission in African individuals after treatment with antiretroviral therapy (ART) in primary HIV infection (PHI). Methods: We studied participants (n ¼ 82) from South Africa and Uganda in Short Pulse Antiretroviral Treatment at HIV-1 Seroconversion, the first trial of treatment interruption in African individuals with PHI randomized to deferred ART or 48 weeks of immediate ART. All were female and infected with non-B HIV subtypes, mainly C. We measured HIV DNA in CD4 þ T cells, CD4 þ cell count, plasma viral load (pVL), cell-associated HIV RNA and T-cell activation and exhaustion. We explored associations with clinical progression and time to pVL rebound after treatment interruption (n ¼ 22). Data were compared with non-African Short Pulse Antiretroviral Treatment at HIV-1 Seroconversion participants. Results: Pretherapy pVL and integrated HIV DNA were lower in Africans compared with non-Africans (median 4.16 vs. 4.72 log 10 copies/ml and 3.07 vs. 3.61 log 10 copies/ million CD4 þ T cells, respectively; P < 0.001). Pre-ART HIV DNA in Africans was associated with clinical progression (P ¼ 0.001, HR per log 10 copies/million CD4 þ T cells increase (95% CI) 5.38 (1.95-14.79)) and time to pVL rebound (P ¼ 0.034, HR per log 10 copies/ml increase 4.33 (1.12-16.84)). After treatment interruption, Africans experienced longer duration of viral remission than non-Africans (P < 0.001; HR 3.90 (1.75-8.71). Five of 22 African participants (22.7%) maintained VL less than 400 copies/ml over a median of 188 weeks following treatment interruption. Conclusion: We find evidence of greater probability of virological remission following treatment interruption among African participants, although we are unable to differentiate between sex, ethnicity and viral subtype. The finding warrants further investigation.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Virological remission after antiretroviral therapy interruption in female African HIV seroconverters

Gossez

Martin

Pace

et al. 2019

Aids

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“…In symptomatic patients, the date of infection was estimated as 14 days before the onset of symptoms. In asymptomatic patients, the date of infection was estimated as the midpoint between the last negative and the first positive test or one month before the date of the indeterminate or negative Western blot assay [16][17][18].…”

Section: Definitionsmentioning

confidence: 99%

Acute retroviral syndrome and high baseline viral load are predictors of rapid HIV progression among untreated Argentinean seroconverters

Socías

Sued

Laufer

et al. 2011

Journal of the International AIDS Society

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BackgroundDiagnosis of primary HIV infection (PHI) has important clinical and public health implications. HAART initiation at this stage remains controversial.MethodsOur objective was to identify predictors of disease progression among Argentinean seroconverters during the first year of infection, within a multicentre registry of PHI-patients diagnosed between 1997 and 2008. Cox regression was used to analyze predictors of progression (LT-CD4 < 350 cells/mm3, B, C events or death) at 12 months among untreated patients.ResultsAmong 134 subjects, 74% presented with acute retroviral syndrome (ARS). Seven opportunistic infections (one death), nine B events, and 10 non-AIDS defining serious events were observed. Among the 92 untreated patients, 24 (26%) progressed at 12 months versus three (7%) in the treated group (p = 0.01). The 12-month progression rate among untreated patients with ARS was 34% (95% CI 22.5-46.3) versus 13% (95% CI 1.1-24.7) in asymptomatic patients (p = 0.04). In univariate analysis, ARS, baseline LT-CD4 < 350 cells/mm3, and baseline and six-month viral load (VL) > 100,000 copies/mL were associated with progression. In multivariate analysis, only ARS and baseline VL > 100,000 copies/mL remained independently associated; HR: 8.44 (95% CI 0.97-73.42) and 9.44 (95% CI 1.38-64.68), respectively.ConclusionsIn Argentina, PHI is associated with significant morbidity. HAART should be considered in PHI patients with ARS and high baseline VL to prevent disease progression.

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“…However, similar median intervals have been reported from Japan (<1 year) [ 16 ], Holland (<1 year) [ 24 ], and Germany (8.3 months) [ 26 ], although some reports showed longer median intervals than this report does [ 5 , 20 , 21 , 23 , 27 ]. The reasons suggested for early disease progression include host-related factors such as genetic background, route of infection, and social background; viral factors such as subtype and escape mutations; and the possibility of a selection bias in which severe-status patients were predominantly enrolled in the study [ 28 , 29 ]. The mechanism of early disease progression remains to be clarified, but it must be considered that disease progression is rapid in patients with symptomatic acute HIV-1 infection.…”

Section: Discussionmentioning

confidence: 99%

Disease progression of HIV-1 infection in symptomatic and asymptomatic seroconverters in Osaka, Japan: a retrospective observational study

et al. 2015

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BackgroundEstimates of the interval from HIV-1 infection to disease progression may be affected by selection bias, and data concerning asymptomatic early seroconverters are limited. We examined the interval until disease progression in HIV-1 seroconverters in whom the timing of infection could be estimated within 1 year before diagnosis.MethodsSubjects included newly diagnosed patients at Osaka National Hospital between 2003 and 2010 who had either (1) symptomatic acute HIV-1 infection with a negative or intermediate reaction on Western blotting and a positive reaction on an HIV RNA test (symptomatic acute group) or (2) a positive reaction on Western blotting at diagnosis and a <1-year interval from the last negative HIV test until the first positive test. The latter was divided into symptomatic recent or asymptomatic recent groups based on the presence or absence, respectively, of any transient fever between the last negative and first positive tests. Disease progression was defined as a fall in the CD4 count to <350 cells/microL on 2 consecutive tests, the start of anti-HIV therapy, or the onset of AIDS-indicator diseases. Information was retrospectively collected from medical records.ResultsSubjects included 210 patients: 91 in the symptomatic acute group, 72 in the symptomatic recent group, and 47 in the asymptomatic recent group. In the symptomatic acute (0.8 years) and symptomatic recent (2.2 years) groups, the Kaplan-Meier estimate of median interval until disease progression was significantly shorter than that in the asymptomatic recent group (2.9 years). Multivariate analysis by Cox’s proportional hazards test showed that the symptomatic acute group (vs. asymptomatic recent group: hazard ratio: 1.93; 95% confidence interval: 1.14–3.36; p = 0.0140) and a baseline CD4 count of <400 cells/microL (hazard ratio: 3.88; 95% confidence interval: 2.57–5.96; p < 0.0001) were independent prognostic factors associated with early disease progression.ConclusionsSymptomatic seroconversion was associated with early disease progression. Furthermore, the estimated median interval until the CD4 count was <350 cells/microL was only 2.9 years even in patients with asymptomatic seroconversion. These results suggest the importance of early diagnosis in early seroconverters.

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Comparison of Early CD4 T-Cell Count in HIV-1 Seroconverters in Côte d'Ivoire and France: The ANRS PRIMO-CI and SEROCO Cohorts

Abstract: CD4+ count and percentage were lower in CI than in France. These differences were already observed during early infection and remained similar after adjustment.

Cited by 9 publications

References 33 publications

Virological remission after antiretroviral therapy interruption in female African HIV seroconverters

Virological remission after antiretroviral therapy interruption in female African HIV seroconverters

Acute retroviral syndrome and high baseline viral load are predictors of rapid HIV progression among untreated Argentinean seroconverters

Disease progression of HIV-1 infection in symptomatic and asymptomatic seroconverters in Osaka, Japan: a retrospective observational study

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