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Meta-Analysis
. 2023 Jun 8;76(11):2027-2037.
doi: 10.1093/cid/ciad177.

Contribution of Low CD4 Cell Counts and High Human Immunodeficiency Virus (HIV) Viral Load to the Efficacy of Preferred First-Line Antiretroviral Regimens for Treating HIV Infection: A Systematic Review and Meta-Analysis

Jose A Perez-Molina  1   2   3 , Clara Crespillo-Andújar  1   2   3 , Javier Zamora  2   4   5   6 , Borja M Fernández-Félix  2   4   5 , Andrea Gaetano-Gil  2   4   5 , Juan C López-Bernaldo de Quirós  3   7   8 , Sergio Serrano-Villar  1   2   3 , Santiago Moreno  1   2   3 , Noelia Álvarez-Díaz  9 , Juan Berenguer  3   7   8
Affiliations
Meta-Analysis

Contribution of Low CD4 Cell Counts and High Human Immunodeficiency Virus (HIV) Viral Load to the Efficacy of Preferred First-Line Antiretroviral Regimens for Treating HIV Infection: A Systematic Review and Meta-Analysis

Jose A Perez-Molina et al. Clin Infect Dis. .

Abstract

We assessed whether low CD4 count and high viral load (VL) affect the response to currently preferred ART. We performed a systematic review of randomized, controlled clinical trials that analyzed preferred first-line ART and a subgroup analysis by CD4 count (≤ or >200 CD4/μL) or VL (≤ or >100 000 copies/mL). We computed the odds ratio (OR) of treatment failure (TF) for each subgroup and individual treatment arm. Patients with ≤200 CD4 cells or VL ≥100 000 copies/mL showed an increased likelihood of TF at 48 weeks: OR, 1.94; 95% confidence interval (CI): 1.45-2.61 and OR, 1.75; 95% CI: 1.30-2.35, respectively. A similar increase in the risk of TF was observed at 96 weeks. There was no significant heterogeneity regarding integrase strand transfer inhibitor or nucleoside reverse transcriptase inhibitor backbone. Our results show that CD4 <200 cells/μL and VL ≥100,000 copies/mL impair ART efficacy in all preferred regimens.

Keywords: CD4 cell; antiretrovirals; late presenter; meta-analysis; systematic review.

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Conflict of interest statement

Potential conflicts of interest. J. A. P. M. reports consulting fees from Gilead Sciences and GSK; honoraria for advisory boards or public speaking from Gilead Sciences, GSK, and ViiV Healthcare; nonfinancial travel support from ViiV Healthcare and Gilead Sciences; and research grants from Gilead Sciences and ViiV Healthcare. S. M. reports participation on data and safety monitoring boards or advisory boards, speaking activities for which they received payment or honoraria, travel support, and grants for research from Gilead Sciences, Janssen Cilag, Merck Sharp & Dohme, and ViiV Healthcare. S. S. V. reports personal fees from ViiV Healthcare and Janssen Cilag; payment or honoraria from Gilead Sciences and MSD; consulting fees from Mikrobiomik and Aptatargets; nonfinancial travel and/or meeting support from ViiV Healthcare and Gilead Sciences; issued or pending patents for microbiome-associated biomarkers of anal cancer and severe acute respiratory syndrome coronavirus 2 susceptibility test in saliva; and research grants from MSD and Gilead Sciences. J. C. L. B. Q. reports consulting fees from ViiV Healthcare and MSD; honoraria for advice or public speaking from Gilead Sciences, MSD, Janssen Cilag, and ViiV Healthcare; and travel support and grants from ViiV Healthcare. J. B. reports consulting fees from Gilead Sciences, ViiV Healthcare, and GSK; honoraria for advice or public speaking from Gilead Sciences, GSK, Janssen Cilag, MSD, and ViiV Healthcare; travel support from MSD and ViiV Healthcare; and grants from Gilead Sciences, MSD, and ViiV Healthcare. All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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