Determinants of response to first HAART regimen in antiretroviral-naïve patients with an estimated time since HIV seroconversion

Rodolphe Thiébaut, H. Jacqmin-Gadda, A. Sarah Walker, Caroline Sabin, Maria Prins, Julia Del Amo, Kholoud Porter, Francois Dabis, Geneviève Chêne, Valerie Beral, Roel Coutinho, Janet H. Darbyshire, Noël Gill, Christine Lee, Laurence Meyer, Giovanni Rezza, Abdel Babiker, Freya Tyrer, Sylvie Lawson-Ayayi, Faroudy BoufassaOsamah Hamouda, Gabriele Poggensee, Benedetta Longo, Patrizio Pezzotti, Giota Touloumi, Angelos Hatzakis, Anastasia Karafoulidou, Olga Katsarou, Ray Brettle, Jorge del Romero, Liselotte van Asten, Akke van der Bij, Ronald Geskus, Court Pedersen, Ildefonso Hernández Aguado, Santiago Pérez-Hoyos, Anne Eskild, Johan N. Bruun, Mette Sannes, Patrick Francioli, Philippe Vanhems, Matthias Egger, Martin Rickenbach, David Cooper, John Kaldor, Tim Ramacciotti, Don Smith, Roberto Muga, Jordi Tor, John Gill, Joan Cayla, Patricia Garcia de Olalla, Nicholas E. Day, Daniela De Angelis

Research output: Contribution to journalArticle

Abstract

Objective: To study the determinants of immunological and virological response to highly active antiretroviral therapy (HAART) in naïve patients, adjusting for time since HIV-1 seroconversion. Design: Data from HIV-cohort studies where dates of seroconversion have been reliably estimated. Methods: In previously untreated patients, short- and long-term marker responses from HAART initiation (three or more antiretroviral drugs) to the end of follow-up or any treatment modification were considered using mixed effects models accounting for undetectable HIV viral load and informative dropout. Results: In total, 943 patients were treated with a first HAART regimen for a median of 29 months. Inadjusted analyses, compared with a reference group of homosexual men without AIDS initiatingtreatment 4 years after seroconversion, injecting drug users (IDUs) were treated at similar CD4 andHIV RNA levels but had poorer short-term virological response (2.54 vs 2.13 log10 HIV-1 RNAcopies/mL at 1.5 months, P=0.03) and poorer long-term immunological response (522 vs 631 cells/mL at 24 months, P <0.0001). Although individuals with AIDS at HAART initiation had lower CD4 counts (206 vs 382 cells/mL, P<0.0001), their immunological responses were similar to those of individuals without AIDS. Similarly, individuals further from seroconversion started HAART at lower CD4 counts (e.g. 311 vs 382 cells/ μL at vs before 9 years from seroconversion, P<0.0001), but had similar CD4 responses. However, they experienced poorer long-term virological response (0.67 log10 copies/mL/year smaller decline, P<0.0001) compared to those treated before 9 years from seroconversion. Conclusion: Taking into account the time elapsed since seroconversion, this study suggests that careful choices of initial treatment should be made and intensive follow-up carried out in high-risk subgroups such as IDUs who have poorer responses.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalHIV Medicine
Volume7
Issue number1
DOIs
StatePublished - Jan 1 2006

Keywords

  • CD4 T lymphocytes
  • HIV RNA
  • HIV infection
  • Longitudinal study
  • Seroconverters

ASJC Scopus subject areas

  • Health Policy
  • Infectious Diseases
  • Pharmacology (medical)

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    Thiébaut, R., Jacqmin-Gadda, H., Walker, A. S., Sabin, C., Prins, M., Del Amo, J., Porter, K., Dabis, F., Chêne, G., Beral, V., Coutinho, R., Darbyshire, J. H., Gill, N., Lee, C., Meyer, L., Rezza, G., Babiker, A., Tyrer, F., Lawson-Ayayi, S., ... De Angelis, D. (2006). Determinants of response to first HAART regimen in antiretroviral-naïve patients with an estimated time since HIV seroconversion. HIV Medicine, 7(1), 1-9. https://doi.org/10.1111/j.1468-1293.2005.00332.x