First-year lymphocyte T CD4+ response to antiretroviral therapy according to the HIV type in the IeDEA West Africa collaboration

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.

Figure 1. Flow diagram of the selection of patients. IeDEA West Africa Collaboration

LTFU: Lost to follow-up in the first year after treatment initiation (see definition in the methods)

Figure 2

Predicted (from piecewise linear mixed model) and observed mean values of CD4 absolute count (95% Confidence Interval) for HIV-1 (a), HIV-2 (b) and dually positive patients (c). IeDEA West Africa Collaboration.

Figure 2

Predicted (from piecewise linear mixed model) and observed mean values of CD4 absolute count (95% Confidence Interval) for HIV-1 (a), HIV-2 (b) and dually positive patients (c). IeDEA West Africa Collaboration.

Figure 3

Estimated mean CD4 response (95% Confidence Interval) during the first year of treatment by HIV type in patients treated with NNRTI (a) and treated with PI (b).