Better Virological Outcomes Among People Living With Human Immunodeficiency Virus (HIV) Initiating Early Antiretroviral Treatment (CD4 Counts ≥500 Cells/μL) in the HIV Prevention Trials Network 071 (PopART) Trial in South Africa

被引：11

作者：

Fatti, Geoffrey ^{[1
,2
]}

Grimwood, Ashraf ^{[1
]}

Nachega, Jean B. ^{[3
,4
,5
,6
,7
]}

Nelson, Jenna A. ^{[3
]}

LaSorda, Kelsea ^{[3
]}

van Zyl, Gert ^{[8
,9
]}

Grobbelaar, Nelis ^{[10
]}

Ayles, Helen ^{[11
,12
]}

Hayes, Richard ^{[13
]}

Beyers, Nulda ^{[14
]}

Fidler, Sarah ^{[15
,16
]}

Bock, Peter ^{[14
]}

机构：

[1] KhethImpilo AIDS Free Living, Cape Town, South Africa

[2] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Global Hlth, Div Epidemiol & Biostat, Cape Town, South Africa

[3] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA 15260 USA

[4] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Infect Dis & Microbiol, Pittsburgh, PA USA

[5] Johns Hopkins Univ, Dept Epidemiol & Int Hlth, Bloomberg Sch Publ Hlth, Baltimore, MD USA

[6] Stellenbosch Univ, Fac Med & Hlth Sci, Dept Med, Cape Town, South Africa

[7] Stellenbosch Univ, Fac Med & Hlth Sci, Ctr Infect Dis, Cape Town, South Africa

[8] Stellenbosch Univ, Fac Med & Hlth Sci, Div Med Virol, Tygerberg, South Africa

[9] Natl Hlth Lab Serv, Tygerberg, South Africa

[10] Anova Hlth Inst, Paarl, South Africa

[11] London Sch Hyg & Trop Med, Dept Clin Res, London, England

[12] Univ Zambia, Zambart, Ridgeway Campus, Lusaka, Zambia

[13] London Sch Hyg & Trop Med, Dept Infect Dis Epidemiol, London, England

[14] Stellenbosch Univ, Fac Med & Hlth Sci, Desmond Tutu TB Ctr, Dept Paediat & Child Hlth, Cape Town, South Africa

[15] Imperial Coll London, Dept Med, London, England

[16] Imperial Coll, Natl Inst Hlth Res, Biomed Res Ctr, London, England

来源：

CLINICAL INFECTIOUS DISEASES | 2020年 / 70卷 / 03期

基金：

美国国家卫生研究院; 比尔及梅琳达.盖茨基金会;

关键词：

HIV/AIDS; early antiretroviral treatment; virological outcomes; baseline CD4 cell count; HPTN 071 (PopART) Trial; VIRAL SUPPRESSION; THERAPY; LYMPHOCYTES; FAILURE;

D O I：

10.1093/cid/ciz214

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. There have been concerns about reduced adherence and human immunodeficiency virus (HIV) virological suppression (VS) among clinically well people initiating antiretroviral therapy (ART) with high pre-ART CD4 cell counts. We compared virological outcomes by pre-ART CD4 count, where universal ART initiation was provided in the HIV Prevention Trials Network 071 (PopART) trial in South Africa prior to routine national and international implementation. Methods. This prospective cohort study included adults initiating ART at facilities providing universal ART since January 2014. VS (<400 copies/mL), confirmed virological failure (VF) (2 consecutive viral loads >1000 copies/mL), and viral rebound were compared between participants in strata of baseline CD4 cell count. Results. The sample included 1901 participants. VS was >= 94% among participants with baseline CD4 count >= 500 cells/mu L at all 6-month intervals to 30 months. The risk of an elevated viral load (>= 400 copies/mL) was independently lower among participants with baseline CD4 count >= 500 cells/mu L (3.3%) compared to those with CD4 count 200-499 cells/mu L (9.2%) between months 18 and 30 (adjusted relative risk, 0.30 [95% confidence interval,.12-.74]; P =.010). The incidence rate of VF was 7.0, 2.0, and 0.5 per 100 person-years among participants with baseline CD4 count <200, 200-499, and >= 500 cells/mu L, respectively (P<.0001). VF was independently lower among participants with baseline CD4 count >= 500 cells/mu L (adjusted hazard ratio [aHR], 0.23; P=.045) and 3-fold higher among those with baseline CD4 count <200 cells/mu L (aHR, 3.49; P <.0001). Conclusions. Despite previous concerns, participants initiating ART with CD4 counts >= 500 cells/mu L had very good virological outcomes, being better than those with CD4 counts 200-499 cells/mu L.

引用

页码：395 / 403

页数：9

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