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Observational Study
. 2018 May 29;16(1):79.
doi: 10.1186/s12916-018-1046-2.

Switching to dual/monotherapy determines an increase in CD8+ in HIV-infected individuals: an observational cohort study

Cristina Mussini  1 , Patrizia Lorenzini  2 , Alessandro Cozzi-Lepri  3 , Giulia Marchetti  4 , Stefano Rusconi  4 , Andrea Gori  4 , Silvia Nozza  5 , Miriam Lichtner  6 , Andrea Antinori  2 , Andrea Cossarizza  7 , Antonella d'Arminio Monforte  4 ; Icona Foundation Study Group
Collaborators, Affiliations
Observational Study

Switching to dual/monotherapy determines an increase in CD8+ in HIV-infected individuals: an observational cohort study

Cristina Mussini et al. BMC Med. .

Abstract

Background: The CD4/CD8 ratio has been associated with the risk of AIDS and non-AIDS events. We describe trends in immunological parameters in people who underwent a switch to monotherapy or dual therapy, compared to a control group remaining on triple antiretroviral therapy (ART).

Methods: We included patients in Icona who started a three-drug combination ART regimen from an ART-naïve status and achieved a viral load ≤ 50 copies/mL; they were subsequently switched to another triple or to a mono or double regimen. Standard linear regression at fixed points in time (12-24 months after the switch) and linear mixed model analysis with random intercepts and slopes were used to compare CD4 and CD8 counts and their ratio over time according to regimen types (triple vs. dual and vs. mono).

Results: A total of 1241 patients were included; 1073 switched to triple regimens, 104 to dual (72 with 1 nucleoside reverse transcriptase inhibitor (NRTI), 32 NRTI-sparing), and 64 to monotherapy. At 12 months after the switch, for the multivariable linear regression the mean change in the log10 CD4/CD8 ratio for patients on dual therapy was -0.03 (95% confidence interval (CI) -0.05, -0.0002), and the mean change in CD8 count was +99 (95% CI +12.1, +186.3), taking those on triple therapy as reference. In contrast, there was no evidence for a difference in CD4 count change. When using all counts, there was evidence for a significant difference in the slope of the ratio and CD8 count between people who were switched to triple (points/year change ratio = +0.056, CD8 = -25.7) and those to dual regimen (ratio = -0.029, CD8 = +110.4).

Conclusions: We found an increase in CD8 lymphocytes in people who were switched to dual regimens compared to those who were switched to triple. Patients on monotherapy did not show significant differences. The long-term implications of this difference should be ascertained.

Keywords: CD4/CD8 ratio; CD8; Chronic inflammation; Dual therapy; Monotherapy.

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Conflict of interest statement

Ethics approval and consent to participate

The Icona study was approved by ethical committees of all participating centers: Ancona, Bari, Bergamo, Bologna, Brescia, Busto Arsizio, Cagliari, Catania, Chieti, Ferrara, Firenze, Genova, Latina, Lecco, Macerata, Milano, Modena, Monza, Napoli, Padova, Palermo, Perugia, Pescara, Reggio Emilia, Roma, Rovigo, Sassari, Siena, Siracusa, Terni, Torino, Udine, Vicenza, and Viterbo. All subjects participating in the Icona study have signed an informed consent.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow-chart of distribution of the various regimens to which participants were switched
See this image and copyright information in PMC

References

    1. European AIDS Clinical Society Guidelines 2017. www.eacsociety.org/files/guidelines_8.2-english.pdf. Accessed Jan 2017.
    1. DHHS Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. https://aidsinfo.nih.gov/guidelines. Accessed 27 Mar 2018.
    1. Arribas JR, Clumeck N, Nelson M, Hill A, van Delft Y, Moecklinghoff C. The MONET trial: week 144 analysis of the efficacy of darunavir/ritonavir (DRV/r) monotherapy versus DRV/r plus two nucleoside reverse transcriptase inhibitors, for patients with viral load <50 HIV-1 RNA copies/mL at baseline. HIV Med. 2012;13:398–405. doi: 10.1111/j.1468-1293.2012.00989.x. - DOI - PubMed
    1. Valantin MA, Lambert-Niclot S, Flandre P, et al. Long-term efficacy of darunavir/ritonavir monotherapy in patients with HIV-1 viral suppression: week 96 results from the MONOI ANRS 136 study. J Antimicrob Chemother. 2012;67:691–695. doi: 10.1093/jac/dkr504. - DOI - PubMed
    1. Raffi F, Babiker AG, Richert L, et al. Ritonavir-boosted darunavir combined with raltegravir or tenofovir-emtricitabine in antiretroviral-naive adults infected with HIV-1: 96 week results from the NEAT001/ANRS143 randomised non-inferiority trial. Lancet. 2014;384:1942–1951. doi: 10.1016/S0140-6736(14)61170-3. - DOI - PubMed

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