Among Patients with Sustained Viral Suppression in a Resource-limited Setting, CD4 Gains Are Continuous Although Gender-based Differences Occur

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2013 Sep 10

PMID 24013838

Citations 10

Authors

Joseph B Sempa

Agnes N Kiragga

Barbara Castelnuovo

Moses R Kamya

Yukari C Manabe

Affiliations

Soon will be listed here.

Abstract

Introduction: There is conflicting data on long-term CD4 immune recovery after combination antiretroviral therapy (ART) in resource-limited settings. Virologic suppression is rarely documented in cohorts from sub-Saharan Africa so objective evidence of adherence is biologically unsubstantiated. We sought to investigate long-term patterns of immune recovery in Ugandan patients on ART with sustained viral suppression.

Methods: A prospective cohort of patients starting ART between April, 2004 and April, 2005 at the Infectious Diseases Institute with sustained viral suppression (viral load ≤ 400 copies/ml at month 6 and 12) while on first-line ART. Propensity scores were used to adjust for treatment allocation (nevirapine or efavirenz) at ART initiation. Data were analyzed using Kaplan Meier methods and cross-sectional time series regression.

Results: Three hundred and fifty-six patients were included in the analysis.71.6% were female, 87% in WHO stage 3 or 4, median age was 37 years, (IQR:32-43), and median CD4 count was 108 cells/µL, (IQR:35-174) at ART start. At multivariable analysis, lower immune recovery (measured by change in CD4 from ART start at each time interval) was associated with male-gender (-59, 95% CI: 90, -28, P<0.001), baseline CD4 count of 101-200 cells/µL (-35, 95% CI: 62, -9, P=0.009) and >200 (-64, 95% CI: 101, -26, P=0.001), and use of AZT at baseline (-47, 95% CI: -74, -20, P=0.001). Median time to reach >400 cells/µL was longer in males (197.4 weeks, IQR:119.9-312.0), compared to females (144.7 weeks, IQR:96.6-219.7, P<0.001). The cumulative probability of attaining CD4 >400 cells/µL over 7 years was higher in females compared to males (P<0.001).

Conclusions: There was long-term, continuous, immunologic recovery up to 7 years after ART initiation in an urban Ugandan cohort. Virologically suppressed women had better sustained immune recovery than men. Men take longer to immune reconstitute and have a lower probability of reaching a CD4 cell count >400 cells/µL. The biologic mechanisms of these gender differences need further exploration.

Citing Articles

Socio-Behavioural Barriers to Viral Suppression in the Older Adult Population in Rural South Africa.

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Ten-year attrition and antiretroviral therapy response among HIV-positive adults: a sex-based cohort analysis from eight West African countries.

Tiendrebeogo T, Messou E, Arikawa S, Ekouevi D, Tanon A, Kwaghe V J Int AIDS Soc. 2021; 24(5):e25723.

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Immune recovery in HIV-1 infected patients with sustained viral suppression under long-term antiretroviral therapy in Ethiopia.

Wolday D, Legesse D, Kebede Y, Siraj D, McBride J, Striker R PLoS One. 2020; 15(10):e0240880.

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Switching protease inhibitors to rilpivirine in HIV-positive individuals with complete viral suppression and without prior HIV drug resistance in a resource-limited setting: a randomized controlled trial.

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

Sempa J, Rossouw T, Lesaffre E, Nieuwoudt M PLoS One. 2019; 14(11):e0224723.

PMID: 31721805 PMC: 6853324. DOI: 10.1371/journal.pone.0224723.

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