Suboptimal immune recovery during antiretroviral therapy with sustained HIV suppression in sub-Saharan Africa
OBJECTIVE:To assess incidence, determinants and clinical consequences of suboptimal immune recovery in HIV-1 infected adults in sub-Saharan Africa with sustained viral suppression on antiretroviral therapy (ART). DESIGN:Multi-country prospective cohort. METHODS:Suboptimal immune recovery was defined...
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| Veröffentlicht in: | AIDS (London) 2018-05, Vol.32 (8), p.1043-1051 |
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| creator | Kroeze, Stefanie Ondoa, Pascale Kityo, Cissy M Siwale, Margaret Akanmu, Sulaimon Wellington, Maureen de Jager, Marleen Ive, Prudence Mandaliya, Kishor Stevens, Wendy Boender, T Sonia de Pundert, Marieke E Sigaloff, Kim C.E Reiss, Peter Wit, Ferdinand W de Wit, Tobias F Rinke Hamers, Raph L |
| description | OBJECTIVE:To assess incidence, determinants and clinical consequences of suboptimal immune recovery in HIV-1 infected adults in sub-Saharan Africa with sustained viral suppression on antiretroviral therapy (ART).
DESIGN:Multi-country prospective cohort.
METHODS:Suboptimal immune recovery was defined as proportions of participants who failed to attain clinically relevant CD4 cell count thresholds (>200, >350 and >500 cells/μL) despite sustained viral suppression on continuous first-line ART. Participants were censored at the earliest of death, loss to follow-up, last viral load |
| doi_str_mv | 10.1097/QAD.0000000000001801 |
| format | Article |
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DESIGN:Multi-country prospective cohort.
METHODS:Suboptimal immune recovery was defined as proportions of participants who failed to attain clinically relevant CD4 cell count thresholds (>200, >350 and >500 cells/μL) despite sustained viral suppression on continuous first-line ART. Participants were censored at the earliest of death, loss to follow-up, last viral load <50 cps/mL, or database closure. Determinants of immune recovery were assessed using multivariable Cox regression. We estimated incidence rates of AIDS, pulmonary tuberculosis and all-cause mortality for CD4 strata.
RESULTS:1592 participants were included; 60% were women, median age was 37 years (IQR 31–43) and median pre-ART CD4 cell count was 147 cells/μl (IQR 76–215). After six years of ART, suboptimal immune recovery at CD4<200, <350 and <500 cells/μL occurred in 7%, 27% and 57% of participants, respectively. Compared to participants with CD4>500 cells/μL, on-ART incidence rates were 12.5, 4.1, 0.9 times higher for AIDS and 16.9, 3.5 and 2.3 times higher for PTB in participants with CD4<200, 200–349, and 350–499 cells/μL, respectively. All-cause mortality was highest in participants with CD4<200 cells/μL, and comparable across the higher CD4 strata. Older age, male sex and lower pre-ART CD4 cell count were strongly associated with suboptimal immune recovery.
CONCLUSIONS:These findings warrant close clinical and laboratory monitoring until adequate immune reconstitution is achieved and support early ART initiation before decline of CD4 cell count.]]></description><identifier>ISSN: 0269-9370</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0000000000001801</identifier><identifier>PMID: 29547445</identifier><language>eng</language><publisher>England: Copyright Wolters Kluwer Health, Inc</publisher><subject>AIDS/HIV</subject><ispartof>AIDS (London), 2018-05, Vol.32 (8), p.1043-1051</ispartof><rights>Copyright © 2018 Wolters Kluwer Health, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4021-6dc785e221d6c808cba5fa1fa5655d7372594b304b8dede3ac43098ff9268ea73</citedby><cites>FETCH-LOGICAL-c4021-6dc785e221d6c808cba5fa1fa5655d7372594b304b8dede3ac43098ff9268ea73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29547445$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kroeze, Stefanie</creatorcontrib><creatorcontrib>Ondoa, Pascale</creatorcontrib><creatorcontrib>Kityo, Cissy M</creatorcontrib><creatorcontrib>Siwale, Margaret</creatorcontrib><creatorcontrib>Akanmu, Sulaimon</creatorcontrib><creatorcontrib>Wellington, Maureen</creatorcontrib><creatorcontrib>de Jager, Marleen</creatorcontrib><creatorcontrib>Ive, Prudence</creatorcontrib><creatorcontrib>Mandaliya, Kishor</creatorcontrib><creatorcontrib>Stevens, Wendy</creatorcontrib><creatorcontrib>Boender, T Sonia</creatorcontrib><creatorcontrib>de Pundert, Marieke E</creatorcontrib><creatorcontrib>Sigaloff, Kim C.E</creatorcontrib><creatorcontrib>Reiss, Peter</creatorcontrib><creatorcontrib>Wit, Ferdinand W</creatorcontrib><creatorcontrib>de Wit, Tobias F Rinke</creatorcontrib><creatorcontrib>Hamers, Raph L</creatorcontrib><title>Suboptimal immune recovery during antiretroviral therapy with sustained HIV suppression in sub-Saharan Africa</title><title>AIDS (London)</title><addtitle>AIDS</addtitle><description><![CDATA[OBJECTIVE:To assess incidence, determinants and clinical consequences of suboptimal immune recovery in HIV-1 infected adults in sub-Saharan Africa with sustained viral suppression on antiretroviral therapy (ART).
DESIGN:Multi-country prospective cohort.
METHODS:Suboptimal immune recovery was defined as proportions of participants who failed to attain clinically relevant CD4 cell count thresholds (>200, >350 and >500 cells/μL) despite sustained viral suppression on continuous first-line ART. Participants were censored at the earliest of death, loss to follow-up, last viral load <50 cps/mL, or database closure. Determinants of immune recovery were assessed using multivariable Cox regression. We estimated incidence rates of AIDS, pulmonary tuberculosis and all-cause mortality for CD4 strata.
RESULTS:1592 participants were included; 60% were women, median age was 37 years (IQR 31–43) and median pre-ART CD4 cell count was 147 cells/μl (IQR 76–215). After six years of ART, suboptimal immune recovery at CD4<200, <350 and <500 cells/μL occurred in 7%, 27% and 57% of participants, respectively. Compared to participants with CD4>500 cells/μL, on-ART incidence rates were 12.5, 4.1, 0.9 times higher for AIDS and 16.9, 3.5 and 2.3 times higher for PTB in participants with CD4<200, 200–349, and 350–499 cells/μL, respectively. All-cause mortality was highest in participants with CD4<200 cells/μL, and comparable across the higher CD4 strata. Older age, male sex and lower pre-ART CD4 cell count were strongly associated with suboptimal immune recovery.
CONCLUSIONS:These findings warrant close clinical and laboratory monitoring until adequate immune reconstitution is achieved and support early ART initiation before decline of CD4 cell count.]]></description><subject>AIDS/HIV</subject><issn>0269-9370</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kE1r3DAQhkVJaDZp_0EpOubiRLIlSzouadoEAiHk42pkeVyr9VdH8i7776OwaSg9ZC7DwPO-Aw8hXzg748yo87v1tzP2z3DN-Aey4kIVmZSKH5AVy0uTmUKxI3Icwq8ESab1R3KUGymUEHJFhvulnuboB9tTPwzLCBTBTRvAHW0W9ONPasfoESJOG4-Jih2gnXd062NHwxKi9SM09Or6KV3zjBCCn0bqx3TW2b3tLNqRrlv0zn4ih63tA3x-3Sfk8fvlw8VVdnP74_pifZM5wXKelY1TWkKe86Z0mmlXW9la3lpZStmoQuXSiLpgotYNNFBYJwpmdNuavNRgVXFCTve9M05_FgixGnxw0Pd2hGkJVc64MFLK0iRU7FGHUwgIbTVjsoG7irPqRXSVRFf_i06xr68flnqA5i3012wC9B7YTn0EDL_7ZQtYdWD72L3f_QyEsIvI</recordid><startdate>20180515</startdate><enddate>20180515</enddate><creator>Kroeze, Stefanie</creator><creator>Ondoa, Pascale</creator><creator>Kityo, Cissy M</creator><creator>Siwale, Margaret</creator><creator>Akanmu, Sulaimon</creator><creator>Wellington, Maureen</creator><creator>de Jager, Marleen</creator><creator>Ive, Prudence</creator><creator>Mandaliya, Kishor</creator><creator>Stevens, Wendy</creator><creator>Boender, T Sonia</creator><creator>de Pundert, Marieke E</creator><creator>Sigaloff, Kim C.E</creator><creator>Reiss, Peter</creator><creator>Wit, Ferdinand W</creator><creator>de Wit, Tobias F Rinke</creator><creator>Hamers, Raph L</creator><general>Copyright Wolters Kluwer Health, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20180515</creationdate><title>Suboptimal immune recovery during antiretroviral therapy with sustained HIV suppression in sub-Saharan Africa</title><author>Kroeze, Stefanie ; Ondoa, Pascale ; Kityo, Cissy M ; Siwale, Margaret ; Akanmu, Sulaimon ; Wellington, Maureen ; de Jager, Marleen ; Ive, Prudence ; Mandaliya, Kishor ; Stevens, Wendy ; Boender, T Sonia ; de Pundert, Marieke E ; Sigaloff, Kim C.E ; Reiss, Peter ; Wit, Ferdinand W ; de Wit, Tobias F Rinke ; Hamers, Raph L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4021-6dc785e221d6c808cba5fa1fa5655d7372594b304b8dede3ac43098ff9268ea73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>AIDS/HIV</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kroeze, Stefanie</creatorcontrib><creatorcontrib>Ondoa, Pascale</creatorcontrib><creatorcontrib>Kityo, Cissy M</creatorcontrib><creatorcontrib>Siwale, Margaret</creatorcontrib><creatorcontrib>Akanmu, Sulaimon</creatorcontrib><creatorcontrib>Wellington, Maureen</creatorcontrib><creatorcontrib>de Jager, Marleen</creatorcontrib><creatorcontrib>Ive, Prudence</creatorcontrib><creatorcontrib>Mandaliya, Kishor</creatorcontrib><creatorcontrib>Stevens, Wendy</creatorcontrib><creatorcontrib>Boender, T Sonia</creatorcontrib><creatorcontrib>de Pundert, Marieke E</creatorcontrib><creatorcontrib>Sigaloff, Kim C.E</creatorcontrib><creatorcontrib>Reiss, Peter</creatorcontrib><creatorcontrib>Wit, Ferdinand W</creatorcontrib><creatorcontrib>de Wit, Tobias F Rinke</creatorcontrib><creatorcontrib>Hamers, Raph L</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>AIDS (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kroeze, Stefanie</au><au>Ondoa, Pascale</au><au>Kityo, Cissy M</au><au>Siwale, Margaret</au><au>Akanmu, Sulaimon</au><au>Wellington, Maureen</au><au>de Jager, Marleen</au><au>Ive, Prudence</au><au>Mandaliya, Kishor</au><au>Stevens, Wendy</au><au>Boender, T Sonia</au><au>de Pundert, Marieke E</au><au>Sigaloff, Kim C.E</au><au>Reiss, Peter</au><au>Wit, Ferdinand W</au><au>de Wit, Tobias F Rinke</au><au>Hamers, Raph L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Suboptimal immune recovery during antiretroviral therapy with sustained HIV suppression in sub-Saharan Africa</atitle><jtitle>AIDS (London)</jtitle><addtitle>AIDS</addtitle><date>2018-05-15</date><risdate>2018</risdate><volume>32</volume><issue>8</issue><spage>1043</spage><epage>1051</epage><pages>1043-1051</pages><issn>0269-9370</issn><eissn>1473-5571</eissn><abstract><![CDATA[OBJECTIVE:To assess incidence, determinants and clinical consequences of suboptimal immune recovery in HIV-1 infected adults in sub-Saharan Africa with sustained viral suppression on antiretroviral therapy (ART).
DESIGN:Multi-country prospective cohort.
METHODS:Suboptimal immune recovery was defined as proportions of participants who failed to attain clinically relevant CD4 cell count thresholds (>200, >350 and >500 cells/μL) despite sustained viral suppression on continuous first-line ART. Participants were censored at the earliest of death, loss to follow-up, last viral load <50 cps/mL, or database closure. Determinants of immune recovery were assessed using multivariable Cox regression. We estimated incidence rates of AIDS, pulmonary tuberculosis and all-cause mortality for CD4 strata.
RESULTS:1592 participants were included; 60% were women, median age was 37 years (IQR 31–43) and median pre-ART CD4 cell count was 147 cells/μl (IQR 76–215). After six years of ART, suboptimal immune recovery at CD4<200, <350 and <500 cells/μL occurred in 7%, 27% and 57% of participants, respectively. Compared to participants with CD4>500 cells/μL, on-ART incidence rates were 12.5, 4.1, 0.9 times higher for AIDS and 16.9, 3.5 and 2.3 times higher for PTB in participants with CD4<200, 200–349, and 350–499 cells/μL, respectively. All-cause mortality was highest in participants with CD4<200 cells/μL, and comparable across the higher CD4 strata. Older age, male sex and lower pre-ART CD4 cell count were strongly associated with suboptimal immune recovery.
CONCLUSIONS:These findings warrant close clinical and laboratory monitoring until adequate immune reconstitution is achieved and support early ART initiation before decline of CD4 cell count.]]></abstract><cop>England</cop><pub>Copyright Wolters Kluwer Health, Inc</pub><pmid>29547445</pmid><doi>10.1097/QAD.0000000000001801</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | AIDS/HIV |
| title | Suboptimal immune recovery during antiretroviral therapy with sustained HIV suppression in sub-Saharan Africa |
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