Factors associated with a reduced CD4 lymphocyte count response to HAART despite full viral suppression in the EuroSIDA study

Florence, Éric; Lundgren, Jens D.; Dreezen, C; Fisher, M; Kirk, Ole; Blaxhult, Anders; Panos, George; Katlama, Christine; Vella, Stefano; An, Peng

doi:10.1046/j.1468-1293.2003.00156.x

Cited by 170 publications

(175 citation statements)

References 24 publications

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“…However in contrast to present study a cohort study from 9 African countries, also reports the median increase in CD4+ count was significantly higher at 6 and 12 months after receiving ART in patients younger than 50 years; P < 0.001 for both phases [17]. The slower CD4+ cell reconstitution in older patients may be related to an impaired thymic function [18] and CD4 reconstitution has been shown to be age dependent [19,20]. In addition this study showed that 54.6% of ART patients were under the category of clinical stage equal to or above III according to WHO criteria; however this rate was lower than the study reported from Bahir Dar, northern part of Ethiopia, which was 69.7% [21].…”

Section: Discussioncontrasting

confidence: 95%

Trends of Immuno-virological Response Among HIV-Infected Patients Receiving Highly Active Anti-retroviral Therapy at Hawassa, Southern Ethiopia

Hirigo¹

2015

CMR

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Abstract:Background: Immunological and virological response evaluation is one of a critical tool for assessing treatment outcome, regimen change and patient's management. However, data concerning any change in immunological and virological response in HIV infected patients using anti-retroviral treatment (ART) is scarce in Ethiopia. Method: This retrospective cohort study was conducted from April 2010-September 2013 at ART clinic of Hawassa University referral hospital. A total of 86 HIV-infected patients receiving Tenofovir, Stavudine and Zidovudine based regimen with either of Efavirenz or Nevirapine during ART initiation. Lamivudine is common for all. Adequate immune-virological response for most patients under treatment is defined as an increase in CD4 cells of 50-150/µl per year and viral load (VL) drops to undetectable level (<150 copies/ml) after ≥ 6 months of ART. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) Version 20. Results: mean CD4+ cells count shows significant increment at 6, 12, 18 and 24 months after ART treatment among patients having VL <5 (log10) compared to those VL ≥5 (p=0.04; 0.002; < 0.0001; 0.001) respectively. Female have insignificantly better Mean CD4+ cells throughout 24 months. Also patients over 50 years of age do show an immune response after ART initiation. But, in relative to younger patients, their CD4 cells recovery is insignificantly sluggish. CD4+ cells and body weight of concordant positive responders show significant rising trend at 6, 12, 18, 24 months when compared to discordant responders + concordant non-responders (0.003 vs. 0.05; <0.0001 vs. 0.04; 0.001 vs.0.008; 0.001 vs.0.03) respectively. Moreover logistic regression models were applied and significant factors associated with discordant immuno-virological response were patient's body weight (AOR=0.14; 95% CI: 0.03-0.7; p=0.02) and residence (AOR=20.3; 95% CI: 2.2-188; p=0.008). Conclusion: Immunovirological response evaluation is a critical tool for assessing treatment outcome, regimen change and patient's management and the response trend decision should include both CD4+ cells and viral load results concurrently.

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Section: Discussioncontrasting

confidence: 95%

Trends of Immuno-virological Response Among HIV-Infected Patients Receiving Highly Active Anti-retroviral Therapy at Hawassa, Southern Ethiopia

Hirigo¹

2015

CMR

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“…Immune restoration is predicted by several imprinted factors, some of which - such as age, genetic background, history of infection, and nadir of CD4 + cells - are beyond the reach of therapeutic intervention (37)(38)(39)(40)(41)(42)(43). Nevertheless, the length of time patients spend with low CD4 + T cell counts is clearly associated with a higher morbidity in HIV-infected patients (9,10,(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Enhanced T cell recovery in HIV-1–infected adults through IL-7 treatment

Lévy¹,

Lacabaratz²,

Weiss³

et al. 2009

J. Clin. Invest.

253

308

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“…[78][79][80][81][82][83] Some suggests that these finding may be linked with higher adherence in older patients, 78,[84][85] but other authors reported a higher risk of inadequate adherence in HIV patients who have other comorbidities and take other medications besides HAART. [86][87] While virological response seems not to be influenced by age, at least biologically, older patients have lower CD4C T-cell gain compared with younger persons, [88][89][90][91][92][93][94][95] even when adjusted for antiretroviral therapy regimens. This is particularly relevant considering that lower CD4 T-cell counts are not only linked to HIV-related opportunistic infections and malignancies, but also lead to higher risk of non-AIDS-related comorbidities, adding to the already elevated risk conferred by age.…”

Section: Clinical Outcomementioning

confidence: 99%

Immunosenescence and hurdles in the clinical management of older HIV-patients

2017

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People living with HIV (PLWH) who are treated with effective highly active antiretroviral therapy (HAART) have a similar life expectancy to the general population. Moreover, an increasing proportion of new HIV diagnoses are made in people older than 50 y. The number of older HIVinfected patients is thus constantly growing and it is expected that by 2030 around 70% of PLWH will be more than 50 y old. On the other hand, HIV infection itself is responsible for accelerated immunosenescence, a progressive decline of immune system function in both the adaptive and the innate arm, which impairs the ability of an individual to respond to infections and to give rise to long-term immunity; furthermore, older patients tend to have a worse immunological response to HAART.In this review we focus on the pathogenesis of HIV-induced immunosenescence and on the clinical management of older HIV-infected patients.

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Factors associated with a reduced CD4 lymphocyte count response to HAART despite full viral suppression in the EuroSIDA study

Cited by 170 publications

References 24 publications

Trends of Immuno-virological Response Among HIV-Infected Patients Receiving Highly Active Anti-retroviral Therapy at Hawassa, Southern Ethiopia

Trends of Immuno-virological Response Among HIV-Infected Patients Receiving Highly Active Anti-retroviral Therapy at Hawassa, Southern Ethiopia

Enhanced T cell recovery in HIV-1–infected adults through IL-7 treatment

Immunosenescence and hurdles in the clinical management of older HIV-patients

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