First-year lymphocyte T CD4 response to antiretroviral therapy according to the HIV type in the IeDEA West Africa collaboration.Reportar como inadecuado

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* Corresponding author 1 Epidémiologie et Biostatistique Bordeaux 2 SMIT - Service des Maladies Infectieuses et Tropicales 3 Service d-Hépato-Gastro-Entérologie 4 PVVIH - Centre de Prise en Charge des personnes vivant avec le VIH 5 SMIT - Service des Maladies Infectieuses et Tropicales 6 Programme PAC-CI 7 Fajara Cohort 8 SMIT - Service de Maladies Infectieuses et Tropicales

Abstract : OBJECTIVE: To compare the lymphocyte T CD4+ CD4 response to combinations of antiretroviral therapy ART in HIV-1, HIV-2 and dually positive patients in West Africa. DESIGN AND SETTING: Collaboration of 12 prospective cohorts of HIV-infected adults followed in Senegal 2, Gambia 1, Mali 2, Benin 1 and Côte d-Ivoire 6. Subjects: Nine thousand, four hundred and eighty-two patients infected by HIV-1 only, 270 by HIV-2 only and 321 dually positive, who initiated an ART. OUTCOME MEASURES: CD4 change over a 12-month period. RESULTS: Observed CD4 cell counts at treatment initiation were similar in the three groups overall median 155, interquartile range IQR 68; 249 cells-microl. In HIV-1 patients, the most common ART regimen was two nucleoside reverse transcriptase inhibitors NRTIs and one non-nucleoside reverse transcriptase inhibitor NNRTI; N = 7714 as well as for dually positive patients N = 135. HIV-2 patients were most often treated with a protease inhibitor-based regimen N = 193 but 45 of them were treated with an NNRTI-containing ART. In those treated with a NNRTI-containing regimen, the estimated mean CD4 change between 3 and 12 months was significantly lower in HIV-2 -41 cells-microl per year and dually positive patients +12 cells-microl per year compared to HIV-1 patients +69 cells-microl per year, overall P value 0.01. The response in HIV-2 and dually positive patients treated by another regimen triple NRTIs or protease inhibitor-containing ART was not significantly different than the response obtained in HIV-1-only patients all P values >0.30. CONCLUSION: An optimal CD4 response to ART in West Africa requires determining HIV type prior to initiation of antiretroviral drugs. NNRTIs are the mainstay of first-line ART in West Africa but are not adapted to the treatment of HIV-2 and dually positive patients.

Autor: Julia Drylewicz - Serge Eholie - Moussa Maiga - Djimon-Marcel Zannou - Papa-Salif Sow - Didier Ekouevi - Kevin Peterson - Emmanue



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