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Observational Study
. 2023 Jun;24(6):716-726.
doi: 10.1111/hiv.13467. Epub 2023 Feb 15.

Immune response to ART initiation in advanced HIV infection

Karam Mounzer  1 , Laurence Brunet  2 , Jennifer S Fusco  2 , Ian R McNicholl  3 , Megan Dunbar  3 , Michael Sension  4 , Lewis H McCurdy  5 , Gregory P Fusco  2
Affiliations
Free article
Observational Study

Immune response to ART initiation in advanced HIV infection

Karam Mounzer et al. HIV Med. 2023 Jun.
Free article

Abstract

Objectives: Our objective was to compare the immunological responses to commonly used antiretroviral therapy (ART) regimens among people with advanced HIV in the USA and to assess virological outcomes and regimen persistence.

Methods: This study included ART-naïve adults with advanced HIV infection (CD4 cell count <200 cells/μL) initiating ART with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), boosted darunavir (bDRV), dolutegravir (DTG), or elvitegravir (EVG/c)-containing regimens between 1 January 2018 and 31 December 2020 in the Observational Pharmaco-Epidemiology Research and Analysis (OPERA) cohort. Cox proportional hazards models and linear mixed models with random intercept were fit with inverse probability of treatment weighting.

Results: Overall, 1349 people with advanced HIV (816 B/F/TAF, 253 DTG, 146 EVG/c, 134 bDRV) were followed for a median of 22 months. Compared with B/F/TAF, a lower likelihood of achieving a CD4 cell count ≥200 cells/μL was observed with bDRV (hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.60-0.96), DTG (HR 0.82; 95% CI 0.69-0.98), and EVG/c (HR 0.73; 95% CI 0.57-0.93). All groups had a similar pattern of CD4:CD8 ratio changes: a rapid increase in the first 6 months (ranging from +0.15 to +0.16 units), followed by a slower increase thereafter. Only 40 individuals (4%) achieved CD4:CD8 ratio normalization (≥1). B/F/TAF was associated with a faster time to virological suppression (viral load <200 copies/mL) and a slower time to discontinuation compared with other regimens.

Conclusions: Among people with advanced HIV infection, B/F/TAF initiation was associated with faster CD4 cell count recovery and favourable virological outcomes compared with bDRV-, DTG-, and EVG/c-based regimens, although no difference was observed in CD4:CD8 ratio changes over time across regimens.

Keywords: CD4 cell count; CD4:CD8 ratio; advanced HIV; antiretroviral therapy; cohort.

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References

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