Virologic, Immunologic, and Clinical Response to Highly Active Antiretroviral Therapy: the Gender Issue Revisited

Moore, Antonia L.; Kirk, Ole; Johnson, Anne M; Katlama, Christine; Blaxhult, Anders; Dietrich, M.; Colebunders, Robert; Chiesi, Antonio; Lungren, Jens D.; Phillips, Andrew

doi:10.1097/00126334-200304010-00017

Cited by 137 publications

(98 citation statements)

References 30 publications

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“…Data on gender differences in trends of CD4 count after commencement of HAART are inconsistent. In line with the other studies report [23,24] we found no significant differences in CD4+ reconstitution regarding gender. But other reports indicated that females have better immunological reconstitution compared to males [25,26,27,28].…”

Section: Discussionsupporting

confidence: 93%

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: Discussionsupporting

confidence: 93%

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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“…Moreover, published data on determinants of response to HAART are often inconsistent. For example, women may [7,8] or may not [9] exhibit a better virological response than men. Low CD4 count at treatment initiation may be associated with better [8,[10][11][12] or poorer [13,14] immunological response.…”

Section: Introductionmentioning

confidence: 99%

Determinants of response to first HAART regimen in antiretroviral‐naïve patients with an estimated time since HIV seroconversion

et al. 2005

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ObjectiveTo study the determinants of immunological and virological response to highly active antiretroviral therapy (HAART) in naïve patients, adjusting for time since HIV-1 seroconversion. DesignData from HIV-cohort studies where dates of seroconversion have been reliably estimated. MethodsIn previously untreated patients, short-and long-term marker responses from HAART initiation (three or more antiretroviral drugs) to the end of follow-up or any treatment modification were considered using mixed effects models accounting for undetectable HIV viral load and informative dropout. ResultsIn total, 943 patients were treated with a first HAART regimen for a median of 29 months. In adjusted analyses, compared with a reference group of homosexual men without AIDS initiating treatment 4 years after seroconversion, injecting drug users (IDUs) were treated at similar CD4 and HIV RNA levels but had poorer short-term virological response (2.54 vs 2.13 log 10 HIV-1 RNA copies/mL at 1.5 months, P 5 0.03) and poorer long-term immunological response (522 vs 631 cells/ mL at 24 months, Po0.0001). Although individuals with AIDS at HAART initiation had lower CD4 counts (206 vs 382 cells/mL, Po0.0001), their immunological responses were similar to those of individuals without AIDS. Similarly, individuals further from seroconversion started HAART at lower CD4 counts (e.g. 311 vs 382 cells/mL at vs before 9 years from seroconversion, Po0.0001), but had similar CD4 responses. However, they experienced poorer long-term virological response (0.67 log 10 copies/mL/year smaller decline, Po0.0001) compared to those treated before 9 years from seroconversion. ConclusionTaking into account the time elapsed since seroconversion, this study suggests that careful choices of initial treatment should be made and intensive follow-up carried out in high-risk subgroups such as IDUs who have poorer responses.Keywords: CD4 T lymphocytes, HIV infection, HIV RNA, longitudinal study, seroconverters IntroductionThe clinical management of patients infected with HIV is mainly based on two markers -the CD4 T lymphocyte count and the plasma HIV RNA viral load -because of their [8,[10][11][12] or poorer [13,14] immunological response. One possible hypothesis to explain these discrepancies could be that time since seroconversion may influence individual response to antiretroviral treatment and may vary across the categories studied, therefore acting as a confounding factor. In this study, we used data on HIV seroconverters from a large international collaboration to determine whether time elapsed since HIV seroconversion has an independent effect on immunological and virological response to first HAART regimen. Further, we asked whether adjusting for time since seroconversion alters the association of other factors with response to therapy. Methods Study populationCASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) is a collaboration of groups representing 22 cohorts in Europe, Australia and Canada in which the date of HIV-1 seroconver...

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“…This partly agrees with the work of Patterson et al, (2005), who purported that women may achieve virological suppression at a faster rate and have a better immune response than men on starting therapy most likely due to levels of endogenous female hormones, or other sex-linked factors. Sex differences in CD4 cell and clinical responses to HIV infection pre-HAART initiation (Prins et al, 1999;CASCADE Collaboration, 2003) and post-HAART initiation have been reported in some previous studies (Moore et al, 2002;Giordano et al, 2003aGiordano et al, , 2003bMocroft et al, 2000), but not all (Mocroft et al, 2003;Moore et al, 2003). Interestingly, the work of Patterson et al, (2007), show that immunological responses to HAART among previously antiretroviral-naïve patients appear to be similar across sex and age strata in the initial 6 months.…”

Section: Discussionmentioning

confidence: 75%

Effect of highly active antiretroviral therapy (haart) on cd4+ cell count and liver enzymes in HIV infection at Lokoja, Nigeria

Itodo¹,

Enitan²,

Samanu³

et al. 2015

Afr. J. Cell. Path

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Aim:To assess the effect of highly active antiretroviral therapy (HAART) on CD 4 + cell count and liver enzymes in HIV-infected patients six months post-therapy based on age and sex distribution. Methods: A cohort of 200 (66 males, 134 females) consenting HAART naïve patients, aged between 16 and 65 years with confirmed cases of HIV infection (by Western blot method) at Lokoja, Nigeria having a baseline CD 4 + cell counts ≤350 cells/µL were initiated on HAART for six months. Two blood samples were collected, one at pre-HAART (baseline) and the other at post-HAART (follow-up) phase. CD 4 + cells were counted and liver enzymes levels were evaluated using the Partec® Cyflow Counter and Reflotron® Plus Auto-Analyzer, respectively. Results: The immunological outcome of 6 months HAART shows that there was slight increase (statistically, considered not significant, P>0.05) in the post-HAART mean±SEMCD 4 + cell count in the different age and sex strata investigated, when comparison was made with the pre-HAART mean±SEMCD 4 + cell count. Also, the post HAART liver function test show that the liver enzymes levels were not significantly (P>0.05) elevated when compared to the baseline values. Conclusion: Six months of HAART repleted CD 4 + cell counts of HIV-infected patients of different age and sex strata, with no risk of liver damage.

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Virologic, Immunologic, and Clinical Response to Highly Active Antiretroviral Therapy: the Gender Issue Revisited

Abstract: We found no significant evidence of a gender difference in virologic, immunologic, or clinical outcomes after starting HAART.

Cited by 137 publications

References 30 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

Determinants of response to first HAART regimen in antiretroviral‐naïve patients with an estimated time since HIV seroconversion

Effect of highly active antiretroviral therapy (haart) on cd4+ cell count and liver enzymes in HIV infection at Lokoja, Nigeria

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