Immune Reconstitution During the First Year of Antiretroviral Therapy of HIV-1-Infected Adults in Rural Burkina Faso

Abstract

There are no data on the outcome of highly active antiretroviral therapy (HAART) in HIV-infected adults in rural Burkina Faso. We therefore assessed CD4+ T-cell counts and HIV-1 plasma viral load (VL), the proportion of naive T-cells (co-expressing CCR7 and CD45RA) and T-cell activation (expression of CD95 or CD38) in 61 previously untreated adult patients from Nouna, Burkina Faso, at baseline and 2 weeks, 1, 3, 6, 9 and 12 months after starting therapy. Median CD4+ T-cell counts increased from 174 (10th-90th percentile: 33-314) cells/µl at baseline to 300 (114- 505) cells/µl after 3 months and 360 (169-562) cells/µl after 12 months of HAART. Median VL decreased from 5.8 (4.6- 6.6) log10 copies/ml at baseline to 1.6 (1.6-2.3) log10 copies/ml after 12 months. Early CD4+ T-cell recovery was accompanied by a reduction of the expression levels of CD95 and CD38 on T-cells. Out of 42 patients with complete virological follow-up under HAART, 19 (45%) achieved concordant good immunological (gain of ≥100 CD4+ T-cells/µl above baseline) and virological (undetectable VL) responses after 12 months of treatment (intention-to-treat analysis). Neither a decreased expression of the T-cell activation markers CD38 and CD95, nor an increase in the percentage of naive T-cells reliably predicted good virological treatment responses in patients with good CD4+ T-cell reconstitution. Repeated measurement of CD4+ T-cell counts during HAART remains the most important parameter for immunologic monitoring. Substitution of repeated VL testing by determination of T-cell activation levels (e.g., CD38 expression on CD8+ T-cells) should be applied with caution.

Immunological and clinical response to antiretroviral therapy according to baseline CD4+ T-cell count in Karamara General Hospital, Jigjiga, Ethiopia

“…This retrospective cohort study was carried out to assess the trends in CD4 cell recovery and clinical response among HIV patients on ART utilization and the effect of baseline characteristics on CD4 cell count response. CD4+ cell responses was evaluated whether patients failed to attain mean CD4+ cell count increase from baseline of at different interval months (defined as immunological non-response) and whether patients achieved an absolute CD4+ count of 200 cells/μl at the 12th months visit (Kelley et al, 2009) At baseline, the mean CD4 cell count of ART-naïve HIV infected patients was 141 cells/μl, this is comparable with other reports from Tigray (Asfaw et al, 2015) and Burkina faso (Tiba et al, 2012) but higher than the reports from Zewditu hospital Addis Ababa, 81 cells/ul (Moges et al, 2013) and Lao, 41 cells/ul (Bastard et al, 2013). This could be due to the delay in presentation or ART initiation.…”

Association between discordant immunological response to highly active anti-retroviral therapy, regulatory T cell percentage, immune cell activation and very low-level viraemia in HIV-infected patients

“…As an example, this criterion has been used by Piconi et al [39], with a similar study design, mean virological suppression time and proportion of cIR and iIR as our study. Lastly, and most importantly, median HAART durations (before immunological exploration) were shorter in previous studies: 4 years [13], 3 years [54,55] and 12 months [10,55,56]. In contrast, our patients were on HAART for 12 years, with virological success for 7 years.…”

Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria

“…Although our patients presented with very low baseline CD4 counts at both levels of care, the two groups achieved impressive immunologic response to ART in the first year with patients at the prime site achieving significantly higher increases. Studies reporting immunologic response to ART in Africa [ 23 – 25 ] have obtained similar margins of CD4 increase among patients on ART, with slightly lower increases among older age groups. The use of prophylactic agents such as cotrimoxazole among other initiatives will help to further improve immune function and sustain the benefits of ART as programs scale out to rural areas with high burden of OIs.…”