Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation

Objectives No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy (cART) at CD4 counts > 350 cells/μL. It is hypothesized that earlier initiation of cART in asymptomatic and otherwise healthy individuals may lead to poorer...

Full description

Saved in:

Bibliographic Details
Published in:	HIV medicine Vol. 17; no. 5; pp. 368 - 372
Main Authors:	Jose, S, Dunn, D, Cox, A, Fidler, S, Ainsworth, Jonathan, Allan, Sris, Anderson, Jane, Delpech, Valerie, Fisher, Martin, Gazzard, Brian, Gilson, Richard, Gompels, Mark, Hay, Phillip, Hill, Teresa, Johnson, Margaret, Leen, Clifford, Martin, Fabiola, Nelson, Mark, Palfreeman, Adrian, Pillay, Deenan, Sachikonye, Memory, Schwenk, Achim, Tariq, Anjum, Thornton, Alicia, Perry, N, Tilbury, S, Youssef, E, Everett, R, Asboe, D, Taylor, C, Gleisner, Z, Ibrahim, F, Campbell, L, Brima, N, Williams, I, Youle, M, Lampe, F, Smith, C, Tsintas, R, Chaloner, C, Hutchinson, S, Huntington, S, Winston, A, Weber, J, Ramzan, F, Carder, M, Hand, J, Souza, C, Miller, S, Wilson, A, Morris, S, Allan, S, Palfreeman, A, ewszuk, A, Chadwick, D, Cope, E, Gibson, J, Kegg, S, Mitchell, Dr, Hay, P, Martin, F, Russell‐Sharpe, S, Harte, A, Spencer, H, Jones, R, Atkinson, C, Sachikonye, M, Aitken, Celia, Pozniak, Anton, Cane, Patricia, Clark, Duncan, Collins, Simon, Douthwaite, Samuel, Fraser, Christophe, Geretti, Anna Maria, Hué, Stéphane, Kaye, Steve, Kellam, Paul, Lazarus, Linda, Leigh‐Brown, Andrew, Mbisa, Tamyo, Moses, Samuel, Nastouli, Eleni, Smit, Erasmus, Templeton, Kate, Tilston, Peter, Webster, Daniel, Zhang, Hongyi, Greatorex, Jane, Hopkins, Mark, Ashton, Lynn, Booth, Claire, Garcia‐Diaz, Ana, Shepherd, Jill, Schmid, Matthias L, Payne, Brendan, Pere, Spiro, Hubb, Jonathan, Kirk, Stuart, Gunson, Rory
Format:	Journal Article
Language:	English
Published:	England John Wiley and Sons Inc 01-05-2016
Subjects:	Anti-HIV Agents - therapeutic use antiretroviral therapy Antiretroviral Therapy, Highly Active CD4 count CD4 Lymphocyte Count Drug Resistance, Viral - drug effects Female HIV Infections - drug therapy HIV Infections - virology HIV resistance Human immunodeficiency virus Humans Male Mutation Short Communication Treatment Failure virological failure virological failure HIV resistance CD4 count antiretroviral therapy
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Objectives No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy (cART) at CD4 counts > 350 cells/μL. It is hypothesized that earlier initiation of cART in asymptomatic and otherwise healthy individuals may lead to poorer adherence and subsequently higher rates of resistance development. Methods In a large cohort of HIV‐positive individuals, we investigated the emergence of new resistance mutations upon virological treatment failure according to the CD4 count at the initiation of cART. Results Of 7918 included individuals, 6514 (82.3%), 996 (12.6%) and 408 (5.2%) started cART with a CD4 count ≤ 350, 351–499 and ≥ 500 cells/μL, respectively. Virological rebound occurred while on cART in 488 (7.5%), 46 (4.6%) and 30 (7.4%) with a baseline CD4 count ≤ 350, 351–499 and ≥ 500 cells/μL, respectively. Only four (13.0%) individuals with a baseline CD4 count > 350 cells/μL in receipt of a resistance test at viral load rebound were found to have developed new resistance mutations. This compared to 107 (41.2%) of those with virological failure who had initiated cART with a CD4 count < 350 cells/μL. Conclusions We found no evidence of increased rates of resistance development when cART was initiated at CD4 counts above 350 cells/μL.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 The UK CHIC and UK HDRD Steering Committees members are listed in Appendix 1.
ISSN:	1464-2662 1468-1293
DOI:	10.1111/hiv.12302