Predict the Effects of Dolutegravir (DTG) Plus Lamivudine (3TC) on Immunological Responses in People Living with HIV (PLWHIV)

Immune recovery in people living with HIV (PLWHIV) is a residual aspect of antiretroviral treatment (ART) in most patients, but in a non-negligible proportion of them, the CD4+ lymphocytes count, or CD4/CD8 ratio remains suboptimal. We performed a model of the immune response after 24 weeks of switc...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of clinical medicine Vol. 12; no. 3; p. 1176
Main Authors:	Troya, Jesús, Pedrero-Tomé, Roberto, Buzón, Luis, Dueñas, Carlos, On Behalf Of The Spade Study Group
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI AG 01-02-2023 MDPI
Subjects:	Acquired immune deficiency syndrome AIDS Algorithms Antiretroviral drugs Clinical medicine Coronaviruses COVID-19 HIV Human immunodeficiency virus Immunology Lymphocytes Mortality Performance evaluation Population Regression analysis Variables Spain 2DR immune recovery dolutegravir HIV nomograms lamivudine
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Immune recovery in people living with HIV (PLWHIV) is a residual aspect of antiretroviral treatment (ART) in most patients, but in a non-negligible proportion of them, the CD4+ lymphocytes count, or CD4/CD8 ratio remains suboptimal. We performed a model of the immune response after 24 weeks of switching to a 2DR with DTG plus 3TC in a retrospective multicenter cohort of undetectable and experienced patients using significant predictor variables associated with the parameters or situations defined as success and failure. Clinical variables studied were CD4+ and CD8+ lymphocyte count, percentage of CD4, and CD4/CD8 ratio. These parameters were assessed at baseline and 24 weeks after the switch. Based on the evolution of each variable, four categories of immune response and four categories of non-immune response were defined. Immune response was defined as CD4+ count > 500 cells/mm , %CD4 > 30%, CD8+ count < 1000 cells/mm and CD4/CD8 ratio ≥ 0.9. Non-response is just the opposite. In our different models of immunological response, the presence of stage of AIDS ( = 0.035, = 0.065) and current age over 50 years ( = 0.045) are postulated as statistically significative limiting factors in achieving an improvement in CD4, %CD4, CD8, and CD4/CD8 ratio. Late HIV diagnosis ( = 0.156), without statistical significance, enhanced late the previous variables. In contrast, conditions where patients start with CD4 > 500 cells/mm ( = 0.054); CD4 > 30% ( = 0.054, = 0.084); CD8 < 1000 cells/mm ( = 0.018), and CD4/CD8 ≥ 0.9 ( = 0.013, = 0.09) are detected as stimulating or conducive to DTG plus 3TC treatment success. These models represent a proof of concept that could become a valuable tool for clinicians to predict the effects of DTG plus 3TC on immunological responses prior to the switch in undetectable pre-treated PLWHIV with immune dysfunction. The main predictors for immunological failure were late HIV diagnosis, stage of AIDS, and current age over 50 years. In contrast, starting with a normalized immune status was detected as stimulating or conducive to DTG plus 3TC treatment success.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Collaborators of the SPADE Study Group are provided in the Appendix A. These authors contributed equally to this work.
ISSN:	2077-0383 2077-0383
DOI:	10.3390/jcm12031176