Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy

Amanda Mocroft; Andrew N Phillips; Bruno Ledergerber; Colette Smith; Johannes R Bogner; Karine Lacombe; Alicje Wiercinska-Drapalo; Peter Reiss; Ole Kirk; Jens Lundgren; Eurosida Study Group

doi:10.3851/imp1559

Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy

Amanda Mocroft, Andrew N Phillips, Bruno Ledergerber, Colette Smith, Johannes R Bogner, Karine Lacombe, Alicje Wiercinska-Drapalo, Peter Reiss, Ole Kirk, Jens Lundgren, Eurosida Study Group

13 Citations (Scopus)

Abstract

Background: Patients receiving combination antiretroviral therapy (cART) might continue treatment with a virologically failing regimen. We sought to identify annual change in CD4⁺ T-cell count according to levels of viraemia in patients on cART. Methods: A total of 111,371 CD4⁺ T-cell counts and viral load measurements in 8,227 patients were analysed. Annual change in CD4⁺ T-cell numbers was estimated using mixed models. Results: After adjustment, the estimated average annual change in CD4 ⁺ T-cell count significantly increased when viral load was <500 copies/ml (30.4 cells/mm³, 95% confidence interval [CI] 26.6-34.3), was stable when viral load was 500-9,999 copies/ml (3.1 cells/mm³, 95% CI -5.3-11.5) and decreased when viral load was ≥10,000 copies/ml (-14.8 cells/mm³, 95% CI -4.5- - 25.1). Patients taking a boosted protease inhibitor (PI) regimen had more positive annual CD4⁺ T-cell count changes than patients taking other regimens for any given viral load strata: 30.9 cells/mm³ (95% CI 27.7-34.1) when viral load was <500 copies/ml, 14.2 cells/mm³ (95% CI -2.1-30.4) when viral load was 500-9,999 copies/ml and -19.9 cells/mm³ (95% CI -36.6- -3.3) when viral load was ≥10,000 copies/ml. By contrast, among patients taking a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen, the CD4⁺ T-cell count significantly decreased when the viral load was 500-9,999 copies/ml (-18.6 cells/mm³, 95% CI -33.8- - 3.5) and decreased at a faster rate when the viral load was ≥10,000 copies/ml (-44.4 cells/mm³, 95% CI -62.0- -26.9; P=0.0012, test for interaction). Conclusions: On average, CD4⁺ T-cell counts did not significantly decrease until the viral load exceeded 10,000 copies/ml in patients treated with a boosted PI-containing cART regimen, but decreased in patients taking an NNRTI-based cART regimen when viral load was 500-9,999 copies/ml.

Original language	English
Journal	Antiviral Therapy
Volume	15
Issue number	4
Pages (from-to)	563-70
Number of pages	8
ISSN	1359-6535
DOIs	https://doi.org/10.3851/imp1559
Publication status	Published - 1 Jan 2010

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@article{0e263de084f711df928f000ea68e967b,

title = "Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy",

abstract = "Background: Patients receiving combination antiretroviral therapy (cART) might continue treatment with a virologically failing regimen. We sought to identify annual change in CD4+ T-cell count according to levels of viraemia in patients on cART. Methods: A total of 111,371 CD4+ T-cell counts and viral load measurements in 8,227 patients were analysed. Annual change in CD4+ T-cell numbers was estimated using mixed models. Results: After adjustment, the estimated average annual change in CD4 + T-cell count significantly increased when viral load was <500 copies/ml (30.4 cells/mm3, 95% confidence interval [CI] 26.6-34.3), was stable when viral load was 500-9,999 copies/ml (3.1 cells/mm3, 95% CI -5.3-11.5) and decreased when viral load was ≥10,000 copies/ml (-14.8 cells/mm3, 95% CI -4.5- - 25.1). Patients taking a boosted protease inhibitor (PI) regimen had more positive annual CD4+ T-cell count changes than patients taking other regimens for any given viral load strata: 30.9 cells/mm3 (95% CI 27.7-34.1) when viral load was <500 copies/ml, 14.2 cells/mm3 (95% CI -2.1-30.4) when viral load was 500-9,999 copies/ml and -19.9 cells/mm3 (95% CI -36.6- -3.3) when viral load was ≥10,000 copies/ml. By contrast, among patients taking a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen, the CD4+ T-cell count significantly decreased when the viral load was 500-9,999 copies/ml (-18.6 cells/mm3, 95% CI -33.8- - 3.5) and decreased at a faster rate when the viral load was ≥10,000 copies/ml (-44.4 cells/mm3, 95% CI -62.0- -26.9; P=0.0012, test for interaction). Conclusions: On average, CD4+ T-cell counts did not significantly decrease until the viral load exceeded 10,000 copies/ml in patients treated with a boosted PI-containing cART regimen, but decreased in patients taking an NNRTI-based cART regimen when viral load was 500-9,999 copies/ml.",

author = "Amanda Mocroft and Phillips, {Andrew N} and Bruno Ledergerber and Colette Smith and Bogner, {Johannes R} and Karine Lacombe and Alicje Wiercinska-Drapalo and Peter Reiss and Ole Kirk and Jens Lundgren and Ole Kirk",

year = "2010",

month = jan,

day = "1",

doi = "10.3851/imp1559",

language = "English",

volume = "15",

pages = "563--70",

journal = "Antiviral Therapy",

issn = "1359-6535",

publisher = "International Medical Press",

number = "4",

}

TY - JOUR

T1 - Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy

AU - Mocroft, Amanda

AU - Phillips, Andrew N

AU - Ledergerber, Bruno

AU - Smith, Colette

AU - Bogner, Johannes R

AU - Lacombe, Karine

AU - Wiercinska-Drapalo, Alicje

AU - Reiss, Peter

AU - Kirk, Ole

AU - Lundgren, Jens

AU - Eurosida Study Group

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Background: Patients receiving combination antiretroviral therapy (cART) might continue treatment with a virologically failing regimen. We sought to identify annual change in CD4+ T-cell count according to levels of viraemia in patients on cART. Methods: A total of 111,371 CD4+ T-cell counts and viral load measurements in 8,227 patients were analysed. Annual change in CD4+ T-cell numbers was estimated using mixed models. Results: After adjustment, the estimated average annual change in CD4 + T-cell count significantly increased when viral load was <500 copies/ml (30.4 cells/mm3, 95% confidence interval [CI] 26.6-34.3), was stable when viral load was 500-9,999 copies/ml (3.1 cells/mm3, 95% CI -5.3-11.5) and decreased when viral load was ≥10,000 copies/ml (-14.8 cells/mm3, 95% CI -4.5- - 25.1). Patients taking a boosted protease inhibitor (PI) regimen had more positive annual CD4+ T-cell count changes than patients taking other regimens for any given viral load strata: 30.9 cells/mm3 (95% CI 27.7-34.1) when viral load was <500 copies/ml, 14.2 cells/mm3 (95% CI -2.1-30.4) when viral load was 500-9,999 copies/ml and -19.9 cells/mm3 (95% CI -36.6- -3.3) when viral load was ≥10,000 copies/ml. By contrast, among patients taking a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen, the CD4+ T-cell count significantly decreased when the viral load was 500-9,999 copies/ml (-18.6 cells/mm3, 95% CI -33.8- - 3.5) and decreased at a faster rate when the viral load was ≥10,000 copies/ml (-44.4 cells/mm3, 95% CI -62.0- -26.9; P=0.0012, test for interaction). Conclusions: On average, CD4+ T-cell counts did not significantly decrease until the viral load exceeded 10,000 copies/ml in patients treated with a boosted PI-containing cART regimen, but decreased in patients taking an NNRTI-based cART regimen when viral load was 500-9,999 copies/ml.

AB - Background: Patients receiving combination antiretroviral therapy (cART) might continue treatment with a virologically failing regimen. We sought to identify annual change in CD4+ T-cell count according to levels of viraemia in patients on cART. Methods: A total of 111,371 CD4+ T-cell counts and viral load measurements in 8,227 patients were analysed. Annual change in CD4+ T-cell numbers was estimated using mixed models. Results: After adjustment, the estimated average annual change in CD4 + T-cell count significantly increased when viral load was <500 copies/ml (30.4 cells/mm3, 95% confidence interval [CI] 26.6-34.3), was stable when viral load was 500-9,999 copies/ml (3.1 cells/mm3, 95% CI -5.3-11.5) and decreased when viral load was ≥10,000 copies/ml (-14.8 cells/mm3, 95% CI -4.5- - 25.1). Patients taking a boosted protease inhibitor (PI) regimen had more positive annual CD4+ T-cell count changes than patients taking other regimens for any given viral load strata: 30.9 cells/mm3 (95% CI 27.7-34.1) when viral load was <500 copies/ml, 14.2 cells/mm3 (95% CI -2.1-30.4) when viral load was 500-9,999 copies/ml and -19.9 cells/mm3 (95% CI -36.6- -3.3) when viral load was ≥10,000 copies/ml. By contrast, among patients taking a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen, the CD4+ T-cell count significantly decreased when the viral load was 500-9,999 copies/ml (-18.6 cells/mm3, 95% CI -33.8- - 3.5) and decreased at a faster rate when the viral load was ≥10,000 copies/ml (-44.4 cells/mm3, 95% CI -62.0- -26.9; P=0.0012, test for interaction). Conclusions: On average, CD4+ T-cell counts did not significantly decrease until the viral load exceeded 10,000 copies/ml in patients treated with a boosted PI-containing cART regimen, but decreased in patients taking an NNRTI-based cART regimen when viral load was 500-9,999 copies/ml.

U2 - 10.3851/imp1559

DO - 10.3851/imp1559

M3 - Journal article

C2 - 20587849

SN - 1359-6535

VL - 15

SP - 563

EP - 570

JO - Antiviral Therapy

JF - Antiviral Therapy

IS - 4

ER -

Estimated average annual rate of change of CD4(+) T-cell counts in patients on combination antiretroviral therapy

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