Comparing longitudinal CD4 responses to cART among non-perinatally HIV-infected youth versus adults: Results from the HIVRN Cohort

HIV Research Network, Allison Lorna Agwu, John A. Fleishman, Guy Mahiane, Bareng A.S. Nonyane, Keri Althoff, Baligh R. Yehia, Stephen Berry, Richard Rutstein, Ank Nijhawan, W. Christopher Mathews, Judith A. Aberg, Jeanne C Keruly, Richard D Moore, Kelly Gebo, Howard Edelstein, Roberto Corales, Jeffrey Jacobson, Sara Allen, Robert Beil & 13 others Lawrence Hanau, P. Todd Korthuis, Muhammad Akbar, Aditya Gaur, Victoria Sharp, Stephen Arpadi, Charurut Somboonwit, Jonathan Cohn, Fred Hellinger, Irene Fraser, Robert Mills, Faye Malitz, Cindy Voss

Research output: Contribution to journalArticle

Abstract

Background Youth have residual thymic tissue and potentially greater capacity for immune reconstitution than adults after initiation of combination antiretroviral therapy (cART). However, youth face behavioral and psychosocial challenges that may make them more likely than adults to delay ART initiation and less likely to attain similar CD4 outcomes after initiating cART. This study compared CD4 outcomes over time following cART initiation between ART-naïve non-perinatally HIV-infected (nPHIV) youth (13-24 years-old) and adults (≥25-44 yearsold). Methods Retrospective analysis of ART-na?ve nPHIV individuals 13-44 years-old, who initiated their first cART between 2008 and 2011 at clinical sites in the HIV Research Network. A linear mixed model was used to assess the association between CD4 levels after cART initiation and age (13-24, 25-34, 35-44 years), accounting for random variation within participants and between sites, and adjusting for key variables including gender, race/ethnicity, viral load, gaps in care (defined as > 365 days between CD4 tests), and CD4 levels prior to cART initiation (baseline CD4). Results Among 2,595 individuals (435 youth; 2,160 adults), the median follow-up after cART initiation was 179 weeks (IQR 92-249). Baseline CD4 was higher for youth (320 cells/mm3) than for ages 25-34 (293) or 35-44 (258). At 239 weeks after cART initiation, median unadjusted CD4 was higher for youth than adults (576 vs. 539 and 476 cells/mm3, respectively), but this difference was not significant when baseline CD4 was controlled. Compared to those with baseline CD4 ≤200 cells/mm3, individuals with baseline CD4 of 201-500 and >500 cells/ mm3 had greater predicted CD4 levels: 390, 607, and 831, respectively. Additionally, having no gaps in care and higher viral load were associated with better CD4 outcomes. Conclusions Despite having residual thymic tissue, youth attain similar, not superior, CD4 gains as adults. Early ART initiation with minimal delay is as essential to optimizing outcomes for youth as it is for their adult counterparts.

LanguageEnglish (US)
Article numbere0171125
JournalPLoS One
Volume12
Issue number2
DOIs
StatePublished - Feb 1 2017

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HIV
Tissue
therapeutics
Therapeutics
viral load
Viral Load
cells
nationalities and ethnic groups
Linear Models
gender
Research
testing
tissues

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Comparing longitudinal CD4 responses to cART among non-perinatally HIV-infected youth versus adults : Results from the HIVRN Cohort. / HIV Research Network.

In: PLoS One, Vol. 12, No. 2, e0171125, 01.02.2017.

Research output: Contribution to journalArticle

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title = "Comparing longitudinal CD4 responses to cART among non-perinatally HIV-infected youth versus adults: Results from the HIVRN Cohort",
abstract = "Background Youth have residual thymic tissue and potentially greater capacity for immune reconstitution than adults after initiation of combination antiretroviral therapy (cART). However, youth face behavioral and psychosocial challenges that may make them more likely than adults to delay ART initiation and less likely to attain similar CD4 outcomes after initiating cART. This study compared CD4 outcomes over time following cART initiation between ART-na{\"i}ve non-perinatally HIV-infected (nPHIV) youth (13-24 years-old) and adults (≥25-44 yearsold). Methods Retrospective analysis of ART-na?ve nPHIV individuals 13-44 years-old, who initiated their first cART between 2008 and 2011 at clinical sites in the HIV Research Network. A linear mixed model was used to assess the association between CD4 levels after cART initiation and age (13-24, 25-34, 35-44 years), accounting for random variation within participants and between sites, and adjusting for key variables including gender, race/ethnicity, viral load, gaps in care (defined as > 365 days between CD4 tests), and CD4 levels prior to cART initiation (baseline CD4). Results Among 2,595 individuals (435 youth; 2,160 adults), the median follow-up after cART initiation was 179 weeks (IQR 92-249). Baseline CD4 was higher for youth (320 cells/mm3) than for ages 25-34 (293) or 35-44 (258). At 239 weeks after cART initiation, median unadjusted CD4 was higher for youth than adults (576 vs. 539 and 476 cells/mm3, respectively), but this difference was not significant when baseline CD4 was controlled. Compared to those with baseline CD4 ≤200 cells/mm3, individuals with baseline CD4 of 201-500 and >500 cells/ mm3 had greater predicted CD4 levels: 390, 607, and 831, respectively. Additionally, having no gaps in care and higher viral load were associated with better CD4 outcomes. Conclusions Despite having residual thymic tissue, youth attain similar, not superior, CD4 gains as adults. Early ART initiation with minimal delay is as essential to optimizing outcomes for youth as it is for their adult counterparts.",
author = "{HIV Research Network} and Agwu, {Allison Lorna} and Fleishman, {John A.} and Guy Mahiane and Nonyane, {Bareng A.S.} and Keri Althoff and Yehia, {Baligh R.} and Stephen Berry and Richard Rutstein and Ank Nijhawan and Mathews, {W. Christopher} and Aberg, {Judith A.} and Keruly, {Jeanne C} and Moore, {Richard D} and Kelly Gebo and Howard Edelstein and Roberto Corales and Jeffrey Jacobson and Sara Allen and Robert Beil and Lawrence Hanau and Korthuis, {P. Todd} and Muhammad Akbar and Aditya Gaur and Victoria Sharp and Stephen Arpadi and Charurut Somboonwit and Jonathan Cohn and Fred Hellinger and Irene Fraser and Robert Mills and Faye Malitz and Cindy Voss",
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T1 - Comparing longitudinal CD4 responses to cART among non-perinatally HIV-infected youth versus adults

T2 - PLoS One

AU - HIV Research Network

AU - Agwu, Allison Lorna

AU - Fleishman, John A.

AU - Mahiane, Guy

AU - Nonyane, Bareng A.S.

AU - Althoff, Keri

AU - Yehia, Baligh R.

AU - Berry, Stephen

AU - Rutstein, Richard

AU - Nijhawan, Ank

AU - Mathews, W. Christopher

AU - Aberg, Judith A.

AU - Keruly, Jeanne C

AU - Moore, Richard D

AU - Gebo, Kelly

AU - Edelstein, Howard

AU - Corales, Roberto

AU - Jacobson, Jeffrey

AU - Allen, Sara

AU - Beil, Robert

AU - Hanau, Lawrence

AU - Korthuis, P. Todd

AU - Akbar, Muhammad

AU - Gaur, Aditya

AU - Sharp, Victoria

AU - Arpadi, Stephen

AU - Somboonwit, Charurut

AU - Cohn, Jonathan

AU - Hellinger, Fred

AU - Fraser, Irene

AU - Mills, Robert

AU - Malitz, Faye

AU - Voss, Cindy

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background Youth have residual thymic tissue and potentially greater capacity for immune reconstitution than adults after initiation of combination antiretroviral therapy (cART). However, youth face behavioral and psychosocial challenges that may make them more likely than adults to delay ART initiation and less likely to attain similar CD4 outcomes after initiating cART. This study compared CD4 outcomes over time following cART initiation between ART-naïve non-perinatally HIV-infected (nPHIV) youth (13-24 years-old) and adults (≥25-44 yearsold). Methods Retrospective analysis of ART-na?ve nPHIV individuals 13-44 years-old, who initiated their first cART between 2008 and 2011 at clinical sites in the HIV Research Network. A linear mixed model was used to assess the association between CD4 levels after cART initiation and age (13-24, 25-34, 35-44 years), accounting for random variation within participants and between sites, and adjusting for key variables including gender, race/ethnicity, viral load, gaps in care (defined as > 365 days between CD4 tests), and CD4 levels prior to cART initiation (baseline CD4). Results Among 2,595 individuals (435 youth; 2,160 adults), the median follow-up after cART initiation was 179 weeks (IQR 92-249). Baseline CD4 was higher for youth (320 cells/mm3) than for ages 25-34 (293) or 35-44 (258). At 239 weeks after cART initiation, median unadjusted CD4 was higher for youth than adults (576 vs. 539 and 476 cells/mm3, respectively), but this difference was not significant when baseline CD4 was controlled. Compared to those with baseline CD4 ≤200 cells/mm3, individuals with baseline CD4 of 201-500 and >500 cells/ mm3 had greater predicted CD4 levels: 390, 607, and 831, respectively. Additionally, having no gaps in care and higher viral load were associated with better CD4 outcomes. Conclusions Despite having residual thymic tissue, youth attain similar, not superior, CD4 gains as adults. Early ART initiation with minimal delay is as essential to optimizing outcomes for youth as it is for their adult counterparts.

AB - Background Youth have residual thymic tissue and potentially greater capacity for immune reconstitution than adults after initiation of combination antiretroviral therapy (cART). However, youth face behavioral and psychosocial challenges that may make them more likely than adults to delay ART initiation and less likely to attain similar CD4 outcomes after initiating cART. This study compared CD4 outcomes over time following cART initiation between ART-naïve non-perinatally HIV-infected (nPHIV) youth (13-24 years-old) and adults (≥25-44 yearsold). Methods Retrospective analysis of ART-na?ve nPHIV individuals 13-44 years-old, who initiated their first cART between 2008 and 2011 at clinical sites in the HIV Research Network. A linear mixed model was used to assess the association between CD4 levels after cART initiation and age (13-24, 25-34, 35-44 years), accounting for random variation within participants and between sites, and adjusting for key variables including gender, race/ethnicity, viral load, gaps in care (defined as > 365 days between CD4 tests), and CD4 levels prior to cART initiation (baseline CD4). Results Among 2,595 individuals (435 youth; 2,160 adults), the median follow-up after cART initiation was 179 weeks (IQR 92-249). Baseline CD4 was higher for youth (320 cells/mm3) than for ages 25-34 (293) or 35-44 (258). At 239 weeks after cART initiation, median unadjusted CD4 was higher for youth than adults (576 vs. 539 and 476 cells/mm3, respectively), but this difference was not significant when baseline CD4 was controlled. Compared to those with baseline CD4 ≤200 cells/mm3, individuals with baseline CD4 of 201-500 and >500 cells/ mm3 had greater predicted CD4 levels: 390, 607, and 831, respectively. Additionally, having no gaps in care and higher viral load were associated with better CD4 outcomes. Conclusions Despite having residual thymic tissue, youth attain similar, not superior, CD4 gains as adults. Early ART initiation with minimal delay is as essential to optimizing outcomes for youth as it is for their adult counterparts.

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