Rate of decline in CD4 count in HIV patients not on antiretroviral therapy

Patrikar, Seema; Basannar, D.R.; Bhatti, V.K.; Kotwal, Anupam; Gupta, R.M.; Grewal, Rajan

doi:10.1016/j.mjafi.2013.08.005

Cited by 20 publications

(16 citation statements)

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“…It is widely known that the progression of HIV disease is directly related with the time of infection, with late HIV infections associated with CD4 + cell depletion and increased HIV replication [ 50 ]. To determine whether the time of HIV infection was a confounding factor in our study, we analysed the effect of HPgV viral load conditions according to recent or late HIV infection ( S1 Table ).…”

Section: Discussionmentioning

confidence: 99%

High HPgV replication is associated with improved surrogate markers of HIV progression

et al. 2017

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BackgroundHuman Pegivirus (HPgV) may have a beneficial effect on HIV disease progression in co-infected patients; however, the virologic characteristics of this infection are not well defined. In this study, we determined HPgV viremia prevalence in Mexico and provide new insights to understand HPgV infection and HPgV/HIV co-infection.MethodsWe analyzed and quantified 7,890 serum samples for HPgV viremia by One-Step RT-Real-Time PCR, 6,484 from healthy blood donors and 1,406 from HIV-infected patients. Data on HIV progression were obtained from patients’ records. HPgV genotyping was performed in 445 samples by nested PCR of the 5’URT region. Finite Mixture Models were used to identify clustering patterns of HPgV viremia in blood donors and co-infected antiretroviral (ART)-naïve patients.ResultsHPgV was detected in 2.98% of blood donors and 33% of HIV patients, with a wide range of viral loads. The most prevalent genotypes were 3 (58.6%)and 2 (33.7%). HPgV viral loads from healthy blood donors and HPgV/HIV+ ART-naïve co-infected patients were clustered into two component distributions, low and high, with a cut-off point of 5.07log10 and 5.06log10, respectively. High HPgV viremia was associated with improved surrogate markers of HIV infection, independent of the estimated duration of HIV infection or HIV treatment.ConclusionsHPgV prevalence in Mexico was similar to that reported for other countries. The prevalent genotypes could be related to Mexico’s geographic location and ethnicity, since genotype 2 is frequent in the United States and Europe and genotype 3 in Asia and Amerindian populations. HPgV viral load demonstrated two patterns of replication, low and high. The more pronounced beneficial response observed in co-infected patients with high HPgV viremia may explain discrepancies found between other studies. Mechanisms explaining high and low HPgV replication should be explored to determine whether the persistently elevated replication depends on host or viral factors.

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Section: Discussionmentioning

confidence: 99%

High HPgV replication is associated with improved surrogate markers of HIV progression

et al. 2017

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“…This may have resulted in biased model estimates for cVL 2 . However, we did control for baseline CD4 count which, although perhaps not ideal due to inter-patient variability in the rate of CD4 decline prior to ART [53], is frequently used as a surrogate marker for duration of infection [54]. Further, approaches for adjusting for pre-ART VLs, as summarized in a prior study [13], may be of limited value as they are dependent on an individual’s innate viral controlling ability.…”

Section: Discussionmentioning

confidence: 99%

Cumulative viral load as a predictor of CD4+ T-cell response to antiretroviral therapy using Bayesian statistical models

et al. 2019

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IntroductionThere are Challenges in statistically modelling immune responses to longitudinal HIV viral load exposure as a function of covariates. We define Bayesian Markov Chain Monte Carlo mixed effects models to incorporate priors and examine the effect of different distributional assumptions. We prospectively fit these models to an as-yet-unpublished data from the Tshwane District Hospital HIV treatment clinic in South Africa, to determine if cumulative log viral load, an indicator of long-term viral exposure, is a valid predictor of immune response.MethodsModels are defined, to express ‘slope’, i.e. mean annual increase in CD4 counts, and ‘asymptote’, i.e. the odds of having a CD4 count ≥500 cells/μL during antiretroviral treatment, as a function of covariates and random-effects. We compare the effect of using informative versus non-informative prior distributions on model parameters. Models with cubic splines or Skew-normal distributions are also compared using the conditional Deviance Information Criterion.ResultsThe data of 750 patients are analyzed. Overall, models adjusting for cumulative log viral load provide a significantly better fit than those that do not. An increase in cumulative log viral load is associated with a decrease in CD4 count slope (19.6 cells/μL (95% credible interval: 28.26, 10.93)) and a reduction in the odds of achieving a CD4 counts ≥500 cells/μL (0.42 (95% CI: 0.236, 0.730)) during 5 years of therapy. Using informative priors improves the cumulative log viral load estimate, and a skew-normal distribution for the random-intercept and measurement error results is a better fit compared to using classical Gaussian distributions.DiscussionWe demonstrate in an unpublished South African cohort that cumulative log viral load is a strong and significant predictor of both CD4 count slope and asymptote. We argue that Bayesian methods should be used more frequently for such data, given their flexibility to incorporate prior information and non-Gaussian distributions.

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“…However, our results revealed that PLHIV with a low risk of ED had significantly higher self-adherence scores compared to those with a high risk of ED, corresponding with the high discipline of ART administering among PLHIV with a low risk of ED. The CD4 level was also significantly higher in the high-risk ED group, which may help prevent opportunistic infections [25]. The limitations of this study were that information on participants' physical activity was not collected and just one food record was collected for each participant, which might not be enough to validate the composition of food being consumed because they may consume different food during other working days and weekend days.…”

Section: Discussionmentioning

confidence: 96%

Quality of food consumption and development of eating disorders among people living with HIV

Singhato¹,

Booranasuksakul²,

Rueangsri³

et al. 2017

HIV & AIDS Review

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Human immunodeficiency virus (HIV) infection largely impacts on the nutritional status of infected patients. At present, advance in medicine and pharmaceuticals such as antiretroviral drugs help improve health status among people living with HIV (PLHIV). Improving appetite for PLHIV by regaining their normal taste sensation and enhanced naso-oral stimulation can help promote their consumption of larger amounts of food. Previous studies have shown how bad HIV infection affects mental status, which leads to the development of many health problems including eating disorder. This is a cross-sectional study aimed to investigate characteristics of food consumed by PLHIV and comparing that between high-risk and low-risk eating disorder groups. The developed self-respondent questionnaires (baseline questionnaire, eating disorder screening questionnaire, self-adherence questionnaire, and 3-day food record) were completed by 132 HIV infected patients at the Queen Savang Vadhana Memorial Hospital, Chonburi province. The results in a high-risk group were not significant on energy distribution (carbohydrate, protein, fat) compared with a low-risk group, but the data indicated that the high-risk group had a significantly higher intake of saturated fat and sodium compared with the low-risk group. In addition, results indicated that the high-risk group was significantly lower in self-adherent score and CD4 level compared with the low-risk group.

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Rate of decline in CD4 count in HIV patients not on antiretroviral therapy

Abstract: There was a progressive decline in the CD4 count following HIV infection. An understanding of the influence of decline in CD4 count in HIV patients not on ART is important for clinical management of HIV disease.

Cited by 20 publications

References 10 publications

High HPgV replication is associated with improved surrogate markers of HIV progression

High HPgV replication is associated with improved surrogate markers of HIV progression

Cumulative viral load as a predictor of CD4+ T-cell response to antiretroviral therapy using Bayesian statistical models

Quality of food consumption and development of eating disorders among people living with HIV

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