Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal
We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50cells/μL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (
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| Veröffentlicht in: | Médecine et maladies infectieuses 2015-06, Vol.45 (6), p.199-206 |
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| creator | Batista, G. Buvé, A. Ngom Gueye, N.F. Manga, N.M. Diop, M.N. Ndiaye, K. Thiam, A. Ly, F. Diallo, A. Ndour, C.T. Seydi, M. |
| description | We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50cells/μL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load ( |
| doi_str_mv | 10.1016/j.medmal.2015.03.009 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1689310299</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0399077X15000888</els_id><sourcerecordid>1689310299</sourcerecordid><originalsourceid>FETCH-LOGICAL-c478t-d05532c4f6ecfdc45b8ee83d1513255800f8891c8fec1a856edefe9727d691af3</originalsourceid><addsrcrecordid>eNp9kU9v1DAQxS0EotvCN0DIRy4J4yRO7AsS2kK7UiUO_BE3y2uPWa-ycbCdon4LPjJepXDkNIf5vXma9wh5xaBmwPq3x_qE9qTHugHGa2hrAPmEbNjQy6rvJTwlG2ilrGAYvl-Qy5SOAE1h4Tm5aLiEoenZhvzeTT57PdK07MOcfTlIt9cdjWjClLLPS_Zhor98PlA9ZR8xx3DvY8HyAaOeH6jFNPuM1C3jSNdVWuY5YkpnqZ-opiYcQsw0OHq7-1b5yaHJaOmss8cppzP0GSf8occX5JnTY8KXj_OKfP344cv2trr7dLPbvr-rTDeIXFngvG1M53o0zpqO7wWiaC3jrG04FwBOCMmMKE5MC96jRYdyaAbbS6Zde0XerHfnGH4umLI6-WRwHPWEYUmK9UK2DBopC9qtqIkhpYhOzbEEFR8UA3XuQh3V2oU6d6GgVaWLInv96LDsy_qf6G_4BXi3Alj-vPcYVTIlDoO2xGyyssH_3-EPWuqgMw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1689310299</pqid></control><display><type>article</type><title>Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal</title><source>MEDLINE</source><source>ScienceDirect Journals (5 years ago - present)</source><creator>Batista, G. ; Buvé, A. ; Ngom Gueye, N.F. ; Manga, N.M. ; Diop, M.N. ; Ndiaye, K. ; Thiam, A. ; Ly, F. ; Diallo, A. ; Ndour, C.T. ; Seydi, M.</creator><creatorcontrib>Batista, G. ; Buvé, A. ; Ngom Gueye, N.F. ; Manga, N.M. ; Diop, M.N. ; Ndiaye, K. ; Thiam, A. ; Ly, F. ; Diallo, A. ; Ndour, C.T. ; Seydi, M.</creatorcontrib><description>We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50cells/μL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (<50copies/mL).
Logistic regression and Cox's proportional hazards model were used to examine risk factors for SIR and the association between SIR and the risk of new clinical events or death, respectively after six months of ARVT.
One hundred and two (15.5%) of the 657 patients presented with SIR. Age>40years (aOR=1.74, 95% CI=1.10–2.75), baseline CD4≥100cells/μL (aOR=2.06, 95% CI=1.24–3.42), ARVT including AZT (aOR=4.57, 95% CI=1.06–19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR=2.38 95% CI=1.49–3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate=9.78/100 person-years) compared to 168 with a normal recovery (rate=7.75/100 person-years) but the difference was not statistically significant (aHR=1.22, 95% CI=0.85 to 1.74).
SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT.
Déterminer les facteurs de risque et l’incidence des événements cliniques associés à une restauration immunitaire sub-optimale (RIS) définie par une augmentation en CD4, depuis l’inclusion jusqu’à 6 mois de traitement antirétroviral (ARVT), inférieure à 50 cellules/mm3 chez les patients infectés par le VIH-1 ayant une charge virale plasmatique indétectable (< 50 copies/mL).
La régression logistique et le model de Cox ont été utilisés pour examiner les facteurs de risque de la RIS et la relation entre la RIS et le risque de survenue des évènements cliniques ou décès après 6 mois de ARVT, respectivement.
Parmi les 657 patients de l’étude, 102 (15,5 %) ont eu une RIS. L’âge>40ans (ORa=1,74 ; IC95 %=1,10–2,75), CD4 initiaux≥100 cellules/mm3 (ORa=2,06 ; IC95 %=1,24–3,42), ARVT comportant AZT (ORa=4,57 ; IC95 %=1,06–19,76) et la survenue d’infection opportuniste grave durant le premier semestre du ARVT (ORa=2,38; IC95 %=1,49–3,80) étaient associés à une RIS. Après 6 mois de ARVT et jusqu’à 7ans de suivi, 39 patients ont présenté au moins un événement clinique ou décès chez ceux qui ont eu une RIS (taux=9,78/100 personnes-année) contre 168 chez ceux qui avaient une restauration normale (taux=7,75/100 personnes-année) mais la différence n’était pas significative (HRa=1,22 ; IC95 %=0,85–1,74).
La RIS est moins fréquente dans notre contexte et elle ne s’accompagne pas d’une surmortalité, ni d’une augmentation de l’incidence des infections opportunistes.</description><identifier>ISSN: 0399-077X</identifier><identifier>EISSN: 1769-6690</identifier><identifier>DOI: 10.1016/j.medmal.2015.03.009</identifier><identifier>PMID: 25907261</identifier><language>eng</language><publisher>France: Elsevier SAS</publisher><subject>Adult ; Africa ; Afrique ; AIDS-Related Opportunistic Infections - epidemiology ; Anti-HIV Agents - administration & dosage ; Anti-HIV Agents - therapeutic use ; Antiretroviral therapy ; Antiretroviral Therapy, Highly Active ; CD4 ; CD4 Lymphocyte Count ; Cohort Studies ; Comorbidity ; Female ; Follow-Up Studies ; HIV Infections - blood ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV Infections - immunology ; HIV-1 ; Humans ; Incidence ; Male ; Malnutrition - epidemiology ; Marriage ; Middle Aged ; Prognosis ; RIS ; Risk Factors ; Senegal - epidemiology ; SIR ; Traitement antirétroviral ; Treatment Outcome ; Viral Load ; Viremia - blood ; Viremia - drug therapy ; Viremia - epidemiology ; Viremia - immunology</subject><ispartof>Médecine et maladies infectieuses, 2015-06, Vol.45 (6), p.199-206</ispartof><rights>2015 Elsevier Masson SAS</rights><rights>Copyright © 2015 Elsevier Masson SAS. All rights reserved.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c478t-d05532c4f6ecfdc45b8ee83d1513255800f8891c8fec1a856edefe9727d691af3</citedby><cites>FETCH-LOGICAL-c478t-d05532c4f6ecfdc45b8ee83d1513255800f8891c8fec1a856edefe9727d691af3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0399077X15000888$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25907261$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Batista, G.</creatorcontrib><creatorcontrib>Buvé, A.</creatorcontrib><creatorcontrib>Ngom Gueye, N.F.</creatorcontrib><creatorcontrib>Manga, N.M.</creatorcontrib><creatorcontrib>Diop, M.N.</creatorcontrib><creatorcontrib>Ndiaye, K.</creatorcontrib><creatorcontrib>Thiam, A.</creatorcontrib><creatorcontrib>Ly, F.</creatorcontrib><creatorcontrib>Diallo, A.</creatorcontrib><creatorcontrib>Ndour, C.T.</creatorcontrib><creatorcontrib>Seydi, M.</creatorcontrib><title>Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal</title><title>Médecine et maladies infectieuses</title><addtitle>Med Mal Infect</addtitle><description>We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50cells/μL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (<50copies/mL).
Logistic regression and Cox's proportional hazards model were used to examine risk factors for SIR and the association between SIR and the risk of new clinical events or death, respectively after six months of ARVT.
One hundred and two (15.5%) of the 657 patients presented with SIR. Age>40years (aOR=1.74, 95% CI=1.10–2.75), baseline CD4≥100cells/μL (aOR=2.06, 95% CI=1.24–3.42), ARVT including AZT (aOR=4.57, 95% CI=1.06–19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR=2.38 95% CI=1.49–3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate=9.78/100 person-years) compared to 168 with a normal recovery (rate=7.75/100 person-years) but the difference was not statistically significant (aHR=1.22, 95% CI=0.85 to 1.74).
SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT.
Déterminer les facteurs de risque et l’incidence des événements cliniques associés à une restauration immunitaire sub-optimale (RIS) définie par une augmentation en CD4, depuis l’inclusion jusqu’à 6 mois de traitement antirétroviral (ARVT), inférieure à 50 cellules/mm3 chez les patients infectés par le VIH-1 ayant une charge virale plasmatique indétectable (< 50 copies/mL).
La régression logistique et le model de Cox ont été utilisés pour examiner les facteurs de risque de la RIS et la relation entre la RIS et le risque de survenue des évènements cliniques ou décès après 6 mois de ARVT, respectivement.
Parmi les 657 patients de l’étude, 102 (15,5 %) ont eu une RIS. L’âge>40ans (ORa=1,74 ; IC95 %=1,10–2,75), CD4 initiaux≥100 cellules/mm3 (ORa=2,06 ; IC95 %=1,24–3,42), ARVT comportant AZT (ORa=4,57 ; IC95 %=1,06–19,76) et la survenue d’infection opportuniste grave durant le premier semestre du ARVT (ORa=2,38; IC95 %=1,49–3,80) étaient associés à une RIS. Après 6 mois de ARVT et jusqu’à 7ans de suivi, 39 patients ont présenté au moins un événement clinique ou décès chez ceux qui ont eu une RIS (taux=9,78/100 personnes-année) contre 168 chez ceux qui avaient une restauration normale (taux=7,75/100 personnes-année) mais la différence n’était pas significative (HRa=1,22 ; IC95 %=0,85–1,74).
La RIS est moins fréquente dans notre contexte et elle ne s’accompagne pas d’une surmortalité, ni d’une augmentation de l’incidence des infections opportunistes.</description><subject>Adult</subject><subject>Africa</subject><subject>Afrique</subject><subject>AIDS-Related Opportunistic Infections - epidemiology</subject><subject>Anti-HIV Agents - administration & dosage</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral therapy</subject><subject>Antiretroviral Therapy, Highly Active</subject><subject>CD4</subject><subject>CD4 Lymphocyte Count</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>HIV Infections - blood</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - immunology</subject><subject>HIV-1</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Malnutrition - epidemiology</subject><subject>Marriage</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>RIS</subject><subject>Risk Factors</subject><subject>Senegal - epidemiology</subject><subject>SIR</subject><subject>Traitement antirétroviral</subject><subject>Treatment Outcome</subject><subject>Viral Load</subject><subject>Viremia - blood</subject><subject>Viremia - drug therapy</subject><subject>Viremia - epidemiology</subject><subject>Viremia - immunology</subject><issn>0399-077X</issn><issn>1769-6690</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9v1DAQxS0EotvCN0DIRy4J4yRO7AsS2kK7UiUO_BE3y2uPWa-ycbCdon4LPjJepXDkNIf5vXma9wh5xaBmwPq3x_qE9qTHugHGa2hrAPmEbNjQy6rvJTwlG2ilrGAYvl-Qy5SOAE1h4Tm5aLiEoenZhvzeTT57PdK07MOcfTlIt9cdjWjClLLPS_Zhor98PlA9ZR8xx3DvY8HyAaOeH6jFNPuM1C3jSNdVWuY5YkpnqZ-opiYcQsw0OHq7-1b5yaHJaOmss8cppzP0GSf8occX5JnTY8KXj_OKfP344cv2trr7dLPbvr-rTDeIXFngvG1M53o0zpqO7wWiaC3jrG04FwBOCMmMKE5MC96jRYdyaAbbS6Zde0XerHfnGH4umLI6-WRwHPWEYUmK9UK2DBopC9qtqIkhpYhOzbEEFR8UA3XuQh3V2oU6d6GgVaWLInv96LDsy_qf6G_4BXi3Alj-vPcYVTIlDoO2xGyyssH_3-EPWuqgMw</recordid><startdate>20150601</startdate><enddate>20150601</enddate><creator>Batista, G.</creator><creator>Buvé, A.</creator><creator>Ngom Gueye, N.F.</creator><creator>Manga, N.M.</creator><creator>Diop, M.N.</creator><creator>Ndiaye, K.</creator><creator>Thiam, A.</creator><creator>Ly, F.</creator><creator>Diallo, A.</creator><creator>Ndour, C.T.</creator><creator>Seydi, M.</creator><general>Elsevier SAS</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150601</creationdate><title>Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal</title><author>Batista, G. ; Buvé, A. ; Ngom Gueye, N.F. ; Manga, N.M. ; Diop, M.N. ; Ndiaye, K. ; Thiam, A. ; Ly, F. ; Diallo, A. ; Ndour, C.T. ; Seydi, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c478t-d05532c4f6ecfdc45b8ee83d1513255800f8891c8fec1a856edefe9727d691af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Africa</topic><topic>Afrique</topic><topic>AIDS-Related Opportunistic Infections - epidemiology</topic><topic>Anti-HIV Agents - administration & dosage</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antiretroviral therapy</topic><topic>Antiretroviral Therapy, Highly Active</topic><topic>CD4</topic><topic>CD4 Lymphocyte Count</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>HIV Infections - blood</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - immunology</topic><topic>HIV-1</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Malnutrition - epidemiology</topic><topic>Marriage</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>RIS</topic><topic>Risk Factors</topic><topic>Senegal - epidemiology</topic><topic>SIR</topic><topic>Traitement antirétroviral</topic><topic>Treatment Outcome</topic><topic>Viral Load</topic><topic>Viremia - blood</topic><topic>Viremia - drug therapy</topic><topic>Viremia - epidemiology</topic><topic>Viremia - immunology</topic><toplevel>online_resources</toplevel><creatorcontrib>Batista, G.</creatorcontrib><creatorcontrib>Buvé, A.</creatorcontrib><creatorcontrib>Ngom Gueye, N.F.</creatorcontrib><creatorcontrib>Manga, N.M.</creatorcontrib><creatorcontrib>Diop, M.N.</creatorcontrib><creatorcontrib>Ndiaye, K.</creatorcontrib><creatorcontrib>Thiam, A.</creatorcontrib><creatorcontrib>Ly, F.</creatorcontrib><creatorcontrib>Diallo, A.</creatorcontrib><creatorcontrib>Ndour, C.T.</creatorcontrib><creatorcontrib>Seydi, M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Médecine et maladies infectieuses</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Batista, G.</au><au>Buvé, A.</au><au>Ngom Gueye, N.F.</au><au>Manga, N.M.</au><au>Diop, M.N.</au><au>Ndiaye, K.</au><au>Thiam, A.</au><au>Ly, F.</au><au>Diallo, A.</au><au>Ndour, C.T.</au><au>Seydi, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal</atitle><jtitle>Médecine et maladies infectieuses</jtitle><addtitle>Med Mal Infect</addtitle><date>2015-06-01</date><risdate>2015</risdate><volume>45</volume><issue>6</issue><spage>199</spage><epage>206</epage><pages>199-206</pages><issn>0399-077X</issn><eissn>1769-6690</eissn><abstract>We determined the risk factors and incidence of clinical events associated with suboptimal immune reconstitution (SIR) defined by an increase in CD4 inferior to 50cells/μL, from inclusion up to six months of antiretroviral treatment (ARVT), in patients with an undetectable viral load (<50copies/mL).
Logistic regression and Cox's proportional hazards model were used to examine risk factors for SIR and the association between SIR and the risk of new clinical events or death, respectively after six months of ARVT.
One hundred and two (15.5%) of the 657 patients presented with SIR. Age>40years (aOR=1.74, 95% CI=1.10–2.75), baseline CD4≥100cells/μL (aOR=2.06, 95% CI=1.24–3.42), ARVT including AZT (aOR=4.57, 95% CI=1.06–19.76), and the occurrence of a severe opportunistic infection during the first semester of ARVT (aOR=2.38 95% CI=1.49–3.80) were associated with SIR. After six months of ARVT and up to seven years of follow-up, 39 patients with SIR had presented with an opportunistic infection or death (rate=9.78/100 person-years) compared to 168 with a normal recovery (rate=7.75/100 person-years) but the difference was not statistically significant (aHR=1.22, 95% CI=0.85 to 1.74).
SIR is less common in our country and is not associated with increased mortality or a greater incidence of opportunistic infections after six months of ARVT.
Déterminer les facteurs de risque et l’incidence des événements cliniques associés à une restauration immunitaire sub-optimale (RIS) définie par une augmentation en CD4, depuis l’inclusion jusqu’à 6 mois de traitement antirétroviral (ARVT), inférieure à 50 cellules/mm3 chez les patients infectés par le VIH-1 ayant une charge virale plasmatique indétectable (< 50 copies/mL).
La régression logistique et le model de Cox ont été utilisés pour examiner les facteurs de risque de la RIS et la relation entre la RIS et le risque de survenue des évènements cliniques ou décès après 6 mois de ARVT, respectivement.
Parmi les 657 patients de l’étude, 102 (15,5 %) ont eu une RIS. L’âge>40ans (ORa=1,74 ; IC95 %=1,10–2,75), CD4 initiaux≥100 cellules/mm3 (ORa=2,06 ; IC95 %=1,24–3,42), ARVT comportant AZT (ORa=4,57 ; IC95 %=1,06–19,76) et la survenue d’infection opportuniste grave durant le premier semestre du ARVT (ORa=2,38; IC95 %=1,49–3,80) étaient associés à une RIS. Après 6 mois de ARVT et jusqu’à 7ans de suivi, 39 patients ont présenté au moins un événement clinique ou décès chez ceux qui ont eu une RIS (taux=9,78/100 personnes-année) contre 168 chez ceux qui avaient une restauration normale (taux=7,75/100 personnes-année) mais la différence n’était pas significative (HRa=1,22 ; IC95 %=0,85–1,74).
La RIS est moins fréquente dans notre contexte et elle ne s’accompagne pas d’une surmortalité, ni d’une augmentation de l’incidence des infections opportunistes.</abstract><cop>France</cop><pub>Elsevier SAS</pub><pmid>25907261</pmid><doi>10.1016/j.medmal.2015.03.009</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Médecine et maladies infectieuses, 2015-06, Vol.45 (6), p.199-206 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Adult Africa Afrique AIDS-Related Opportunistic Infections - epidemiology Anti-HIV Agents - administration & dosage Anti-HIV Agents - therapeutic use Antiretroviral therapy Antiretroviral Therapy, Highly Active CD4 CD4 Lymphocyte Count Cohort Studies Comorbidity Female Follow-Up Studies HIV Infections - blood HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - immunology HIV-1 Humans Incidence Male Malnutrition - epidemiology Marriage Middle Aged Prognosis RIS Risk Factors Senegal - epidemiology SIR Traitement antirétroviral Treatment Outcome Viral Load Viremia - blood Viremia - drug therapy Viremia - epidemiology Viremia - immunology |
| title | Initial suboptimal CD4 reconstitution with antiretroviral therapy despite full viral suppression in a cohort of HIV-infected patients in Senegal |
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