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

• Published in: AIDS (London) Vol. 24; no. 7; pp. 1043 - 1050
• Main Authors: Drylewicz, Julia, Eholie, Serge, Maiga, Moussa, Zannou, Djimon Marcel, Sow, Papa Salif, Ekouevi, Didier K, Peterson, Kevin, Bissagnene, Emmanuel, Dabis, François, Thiébaut, Rodolphe
• Format: Journal Article
• Language: English
• Published: England Wolters Kluwer 24.04.2010
• Subjects: Adult; Africa, Western - epidemiology; AIDS/HIV; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes - cytology; CD4-Positive T-Lymphocytes - virology; Female; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - immunology; HIV Infections - virology; HIV Protease Inhibitors - therapeutic use; HIV-1 - immunology; HIV-2 - immunology; Humans; Life Sciences; Male; Middle Aged; Prospective Studies; RNA, Viral - blood; Santé publique et épidémiologie; Viral Load; Young Adult; Africa, Western
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0b013e3283377a06

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. Collaboration of 12 prospective cohorts of HIV-infected adults followed in Senegal (2), Gambia (1), Mali (2), Benin (1) and Côte d'Ivoire (6). 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. CD4 change over a 12-month period. 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). 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.