Journal Article

A comparison of the CD4 response to antiretroviral regimens in patients commencing therapy with low CD4 counts

L. Waters, J. Stebbing, R. Jones, C. Michailidis, S. Sawleshwarkar, S. Mandalia, M. Bower, M. Nelson and B. Gazzard

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 54, issue 2, pages 503-507
Published in print August 2004 | ISSN: 0305-7453
Published online August 2004 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dkh329
A comparison of the CD4 response to antiretroviral regimens in patients commencing therapy with low CD4 counts

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Objective: To compare the immunological response to highly active antiretroviral therapy (HAART) in treatment-naive patients with a baseline CD4 count of <200 cells/mm3.

Design and methods: We identified treatment-naive human immunodeficiency virus (HIV-1)-infected individuals who had commenced HAART since 1996 and who had a starting CD4 count of <200 cells/mm3. Immunological success was defined as achieving a CD4 count of >200 cells/mm3 and treatments were compared using univariate and multivariate Cox's proportional hazards models in order to establish whether protease inhibitor (PI)-based regimens were significantly different to regimens based on non-nucleoside reverse transcriptase inhibitors (NNRTIs). Both regimens utilize a nucleoside analogue (NA) backbone.

Results: A total of 599 patients were identified. When the variables were entered into a multivariate analysis, no significant differences between HAART regimens were found. We showed that compared with efavirenz regimens a two NA plus one PI regimen was not significantly less likely to achieve immunological success (adjusted HR: 0.65, 95% CI 0.41–1.03, P=0.07). Two NA and boosted PI (adjusted HR: 1.33, 95% CI 0.81 to 2.16) or two NA and nevirapine (adjusted HR: 0.93, 95% CI 0.67–1.29) regimens were also not significantly different from efavirenz-based regimens, based on the endpoint of immunological success.

Conclusion: PI-, boosted PI- and NNRTI-based HAART regimens are not significantly different in achieving increased CD4 counts in individuals who commence therapy with a low CD4 count.

Keywords: HAART; immune; PI; NNRTI; boosted

Journal Article.  3529 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

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