Virologic and Immunologic Response to cART by HIV-1 Subtype in the CASCADE Collaboration

Abstract

BackgroundWe aimed to compare rates of virologic response and CD4 changes after combination antiretroviral (cART) initiation in individuals infected with B and specific non-B HIV subtypes.MethodsUsing CASCADE data we analyzed HIV-RNA and CD4 counts for persons infected ≥1996, ≥15 years of age. We used survival and longitudinal modeling to estimate probabilities of virologic response (confirmed HIV-RNA <500 c/ml), and failure (HIV-RNA>500 c/ml at 6 months or ≥1000 c/ml following response) and CD4 increase after cART initiation.Results2003 (1706 B, 142 CRF02_AG, 55 A, 53 C, 47 CRF01_AE) seroconverters were included in analysis. There was no evidence of subtype effect overall for response or failure (p = 0.075 and 0.317, respectively) although there was a suggestion that those infected with subtypes CRF01_AE and A responded sooner than those with subtype B infection [HR (95% CI):1.37 (1.01–1.86) and 1.29 (0.96–1.72), respectively]. Rates of CD4 increase were similar in all subtypes except subtype A, which tended to have lower initial, but faster long-term, increases.ConclusionsVirologic and immunologic response to cART was similar across all studied subtypes but statistical power was limited by the rarity of some non-B subtypes. Current antiretroviral agents seem to have similar efficacy in subtype B and most widely encountered non-B infections in high-income countries.

Immunological and virological response to antiretroviral treatment in migrant and native men and women in Western Europe; is benefit equal for all?

“…Legal barriers also exist despite all public health recommendations and scientific evidence supporting universal access to HIV testing and treatment; this is still denied to undocumented migrants in some European countries . Migrants are thought to have poorer adherence secondary to socio‐economic factors . Whereas this has previously been shown for some groups of migrants, our data illustrate that this finding cannot be generalized to all migrant groups.…”

“…Data on administrative/legal status for migrant populations in COHERE are not collected. Viral clade and subtype data were not available for this analysis, but the CASCADE Collaboration in EuroCoord has found no clinically relevant differences in either immunological or virological response to cART by HIV‐1 subtype .…”

Genetic Characterization of a Panel of Diverse HIV-1 Isolates at Seven International Sites

“…Distinct prevalence of drug resistance mutations (DRMs) and kinetics of DRM emergence were observed among HIV-1 subtypes [ 14 – 18 ], although other studies indicated that outcomes of antiretroviral therapies (ART) may not be affected by subtypes and differences in virological and immunologic responses to ART might be contributed by ethnicity and/or adherences [ 19 – 21 ]. Drug resistance mutations (DRMs) are a major cause of antiretroviral therapy failure, and hence surveillance for the emergence of drug resistance among all subtypes and recombinants has been implemented in ART programs.…”

Comparing Abbott m2000 RealTime HIV test and Roche COBAS Ampliprep/COBAS Taqman HIV test, v2.0 in treated HIV‐1 B and non‐B subjects with low viraemia

“…There is evidence that the ongoing residual viraemia, up to 200 copies/ml, for 6–9 months enhances the risk of virologic failure [Laprise et al, ]. On contrary, there are studies that do not relate residual viraemia with increased risk of virologic failure [Scherrer et al, ; Charpentier et al, ; Touloumi et al, ; Charpentier et al, ]. In this study, no difference in rates of virological failure was observed between the two groups, above and below 50 copies/ml, after 1 year of follow‐up.…”