University of Surrey

Test tubes in the lab Research in the ATI Dance Research

Role of HIV infection duration and CD4 cell level at initiation of combination anti-retroviral therapy on risk of failure.

Lodi, S, Phillips, A, Fidler, S, Hawkins, D, Gilson, R, McLean, K, Fisher, M, Post, F, Johnson, AM, Walker-Nthenda, L , Dunn, D, Porter, K and UK Register of HIV, (2013) Role of HIV infection duration and CD4 cell level at initiation of combination anti-retroviral therapy on risk of failure. PLoS One, 8 (9).

Full text not available from this repository.

Abstract

BACKGROUND: The development of HIV drug resistance and subsequent virological failure are often cited as potential disadvantages of early cART initiation. However, their long-term probability is not known, and neither is the role of duration of infection at the time of initiation. METHODS: Patients enrolled in the UK Register of HIV seroconverters were followed-up from cART initiation to last HIV-RNA measurement. Through survival analysis we examined predictors of virologic failure (2HIV-RNA ≥400 c/l while on cART) including CD4 count and HIV duration at initiation. We also estimated the cumulative probabilities of failure and drug resistance (from the available HIV nucleotide sequences) for early initiators (cART within 12 months of seroconversion). RESULTS: Of 1075 starting cART at a median (IQR) CD4 count 272 (190,370) cells/mm(3) and HIV duration 3 (1,6) years, virological failure occurred in 163 (15%). Higher CD4 count at initiation, but not HIV infection duration at cART initiation, was independently associated with lower risk of failure (p=0.033 and 0.592 respectively). Among 230 patients initiating cART early, 97 (42%) discontinued it after a median of 7 months; cumulative probabilities of resistance and failure by 8 years were 7% (95% CI 4,11) and 19% (13,25), respectively. CONCLUSION: Although the rate of discontinuation of early cART in our cohort was high, the long-term rate of virological failure was low. Our data do not support early cART initiation being associated with increased risk of failure and drug resistance.

Item Type: Article
Authors :
NameEmailORCID
Lodi, SUNSPECIFIEDUNSPECIFIED
Phillips, AUNSPECIFIEDUNSPECIFIED
Fidler, SUNSPECIFIEDUNSPECIFIED
Hawkins, DUNSPECIFIEDUNSPECIFIED
Gilson, RUNSPECIFIEDUNSPECIFIED
McLean, KUNSPECIFIEDUNSPECIFIED
Fisher, MUNSPECIFIEDUNSPECIFIED
Post, FUNSPECIFIEDUNSPECIFIED
Johnson, AMUNSPECIFIEDUNSPECIFIED
Walker-Nthenda, LUNSPECIFIEDUNSPECIFIED
Dunn, DUNSPECIFIEDUNSPECIFIED
Porter, KUNSPECIFIEDUNSPECIFIED
UK Register of HIV, UNSPECIFIEDUNSPECIFIED
Date : 2013
Identification Number : 10.1371/journal.pone.0075608
Uncontrolled Keywords : Anti-HIV Agents, Anti-Retroviral Agents, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes, Drug Resistance, Viral, Drug Therapy, Combination, Female, HIV, HIV Infections, HIV Seropositivity, Humans, Male, Risk, Treatment Failure
Related URLs :
Depositing User : Symplectic Elements
Date Deposited : 17 May 2017 13:05
Last Modified : 17 May 2017 13:05
URI: http://epubs.surrey.ac.uk/id/eprint/837861

Actions (login required)

View Item View Item

Downloads

Downloads per month over past year


Information about this web site

© The University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom.
+44 (0)1483 300800