دورية أكاديمية
Better virological outcomes amongst people living with HIV initiating early antiretroviral treatment (CD4 counts ≥ 500 cells/µL) in the HPTN 071 (PopART) trial in South Africa
| العنوان: | Better virological outcomes amongst people living with HIV initiating early antiretroviral treatment (CD4 counts ≥ 500 cells/µL) in the HPTN 071 (PopART) trial in South Africa |
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| المؤلفون: | Fatti, G, Grimwood, A, Nachega, JB, Nelson, JA, LaSorda, K, Zyl, GV, Grobbelaar, N, Ayles, H, Hayes, R, Beyers, N, Fidler, S, Bock, P, HPTN 071 (PopART) study team |
| المساهمون: | National Institutes of Health, Imperial College Healthcare NHS Trust- BRC Funding, Medical Research Council (MRC), Department for International Development (UK) (DFI |
| المصدر: | 403 ; 395 |
| بيانات النشر: | Oxford University Press (OUP) |
| سنة النشر: | 2019 |
| المجموعة: | Imperial College London: Spiral |
| مصطلحات موضوعية: | HIV/AIDS, HPTN 071 (PopART) Trial, baseline CD4 cell count, early antiretroviral treatment, virological outcomes, Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, Microbiology, VIRAL SUPPRESSION, THERAPY, LYMPHOCYTES, FAILURE, Adult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, HIV, HIV Infections, Humans, Prospective Studies, South Africa, Viral Load, 06 Biological Sciences, 11 Medical and Health Sciences |
| جغرافية الموضوع: | United States |
| الوصف: | BACKGROUND: There have been concerns about reduced adherence and HIV virological suppression (VS) amongst clinically well people living with HIV initiating antiretroviral treatment (ART) with high pre-ART CD4 cell counts. We compared virological outcomes by pre-ART CD4 count, where universal ART initiation was provided in the HPTN 071 (PopART) trial in South Africa prior to routine national and international implementation. METHODS: This prospective cohort study included adults initiating ART at facilities providing ART irrespective of CD4 count since January 2014. VS (<400 copies/ml), confirmed virological failure (VF) (two consecutive viral loads>1000 copies/ml) and viral rebound were compared between participants in strata of baseline CD4 count. RESULTS: The sample included 1901 participants. VS was 94% or greater amongst participants with baseline CD4 count ≥500 cells/µL at all six-monthly intervals to 30 months of ART. The risk of an elevated viral load (≥400 copies/ml) was independently lower amongst participants with baseline CD4 count ≥500 cells/µL (3.3%) compared to those with CD4 count 200-499 cell/µL (9.2%) between months 18-30, adjusted relative risk=0.30 (95% CI: 0.12-0.74, P=0.010). The incidence rate of VF was 7.0, 2.0 and 0.5 per 100 person-years amongst participants with baseline CD4 count <200, 200-499 and ≥500 cells/µL, respectively (P<0.0001). VF was independently lower amongst participants with baseline CD4 count ≥500 cells/µL, adjusted hazard ratio (aHR)=0.23, P=0.045; and three-fold higher amongst those with baseline CD4 count <200 cells/µL, aHR=3.49, P<0.0001. CONCLUSION: Despite previous concerns, participants initiating ART with CD4 counts ≥500 cells/µL had very good virological outcomes, being better than those with CD4 counts 200-499 cells/µL. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| تدمد: | 1058-4838 |
| العلاقة: | Clinical Infectious Diseases; http://hdl.handle.net/10044/1/69352Test; 5 U19 AI 067854-04; RDA02 79560; EPIDVH72; MR/L00528X/1; HPTN071 Substudy:Phylo PopART; PO15001410 (UMIAI068619); N/A; RDA02 |
| DOI: | 10.1093/cid/ciz214 |
| الإتاحة: | https://doi.org/10.1093/cid/ciz214Test http://hdl.handle.net/10044/1/69352Test |
| حقوق: | © 2019 American Chemical Society. This is an open access article published under an ACS AuthorChoice License, which permits copying and redistribution of the article or any adaptations for non-commercial purposes. |
| رقم الانضمام: | edsbas.7AE7D76C |
| قاعدة البيانات: | BASE |
| تدمد: | 10584838 |
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| DOI: | 10.1093/cid/ciz214 |