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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation
HIV Medicine, Volume 17, No. 5, Year 2016
Notification
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Description
Objectives: No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy (cART) at CD4 counts > 350 cells/μL. It is hypothesized that earlier initiation of cART in asymptomatic and otherwise healthy individuals may lead to poorer adherence and subsequently higher rates of resistance development. Methods: In a large cohort of HIV-positive individuals, we investigated the emergence of new resistance mutations upon virological treatment failure according to the CD4 count at the initiation of cART. Results: Of 7918 included individuals, 6514 (82.3%), 996 (12.6%) and 408 (5.2%) started cART with a CD4 count ≤ 350, 351-499 and ≥ 500 cells/μL, respectively. Virological rebound occurred while on cART in 488 (7.5%), 46 (4.6%) and 30 (7.4%) with a baseline CD4 count ≤ 350, 351-499 and ≥ 500 cells/μL, respectively. Only four (13.0%) individuals with a baseline CD4 count > 350 cells/μL in receipt of a resistance test at viral load rebound were found to have developed new resistance mutations. This compared to 107 (41.2%) of those with virological failure who had initiated cART with a CD4 count < 350 cells/μL. Conclusions: We found no evidence of increased rates of resistance development when cART was initiated at CD4 counts above 350 cells/μL. HIV Medicine © 2016 British HIV Association.
Authors & Co-Authors
Jose, Sophie
United Kingdom, London
University College London
United Kingdom, London
Royal Free London Nhs Foundation Trust
Dunn, David D.
United Kingdom, London
University College London
Cox, Andrew T.
United Kingdom, London
Imperial College Healthcare Nhs Trust
Sabin, Caroline Anne
United Kingdom, London
University College London
United Kingdom, London
Royal Free London Nhs Foundation Trust
Fidler, Sarah J.
United Kingdom, London
Imperial College London
Fisher, Martin
Unknown Affiliation
Gazzard, Brian G.
Unknown Affiliation
Gilson, Richard John Cary
Unknown Affiliation
Gompels, Mark
Unknown Affiliation
Johnson, Margaret A.
Unknown Affiliation
Kegg, Stephen
United Kingdom, London
Lewisham and Greenwich Nhs Trust
Leen, Clifford L.S.
United Kingdom, Edinburgh
Nhs Lothian
Martin, Fabiola
Unknown Affiliation
Nelson, Mark Richard
Unknown Affiliation
Palfreeman, Adrian J.
United Kingdom, Leicester
University Hospitals of Leicester Nhs Trust
Post, Frank A.
Unknown Affiliation
Sachikonye, Memory
Unknown Affiliation
Schwenk, Achim
Unknown Affiliation
Walsh, John Frank
Unknown Affiliation
Hill, Teresa
United Kingdom, London
University College London
Phillips, Andrew N.
United Kingdom, London
University College London
United Kingdom, London
Royal Free London Nhs Foundation Trust
Sabin, Caroline A.
United Kingdom, London
University College London
United Kingdom, London
Ucl Medical School
Dunn, David T.
United Kingdom, London
University College London
Glabay, Adam J.
United Kingdom, London
University College London
Fisher, Martin J.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Perry, Nicky
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Tilbury, Stuart
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Youssef, Elaney
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Gazzard, Bg S.
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Everett, Rhiannon
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Mandalia, Sundhiya
United Kingdom, London
Chelsea and Westminster Hospital Nhs Foundation Trust
Post, Frank A.
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Korat, Hardik
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Taylor, Christopher B.
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Gleisner, Zachary
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Ibrahim, Fowzia A.
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Campbell, Lucy J.
United Kingdom, London
King's College Hospital Nhs Foundation Trust
Gilson, Richard
United Kingdom, London
University College London
Brima, Nataliya
United Kingdom, London
University College London
Williams, Ian T.
United Kingdom, London
University College London
Johnson, Margaret A.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Youle, Mike S.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Smith, Colette Joanne
United Kingdom, London
Royal Free London Nhs Foundation Trust
Tsintas, Robert
United Kingdom, London
Royal Free London Nhs Foundation Trust
Chaloner, Clinton
United Kingdom, London
Royal Free London Nhs Foundation Trust
Hutchinson, Samantha
United Kingdom, London
Royal Free London Nhs Foundation Trust
Hill, Teresa
United Kingdom, London
Royal Free London Nhs Foundation Trust
Thornton, Alicia Claire
United Kingdom, London
Royal Free London Nhs Foundation Trust
Huntington, Susie E.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Walsh, John Christopher
United Kingdom, London
Imperial College Healthcare Nhs Trust
MacKie, Nicola E.
United Kingdom, London
Imperial College Healthcare Nhs Trust
Winston, Alan
United Kingdom, London
Imperial College Healthcare Nhs Trust
Weber, Jonathan N.
United Kingdom, London
Imperial College Healthcare Nhs Trust
Ramzan, Farhan
United Kingdom, London
Imperial College Healthcare Nhs Trust
Carder, Mark
United Kingdom, London
Imperial College Healthcare Nhs Trust
Orkin, Chloë M.
United Kingdom, London
Barts Health Nhs Trust
Lynch, Janet
United Kingdom, London
Barts Health Nhs Trust
Hand, James
United Kingdom, London
Barts Health Nhs Trust
de Souza, Carl B.S.S.
United Kingdom, London
Barts Health Nhs Trust
Anderson, Jane
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Munshi, Sajid
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Ainsworth, Jonathan G.
United Kingdom, London
North Middlesex University Hospital Nhs Trust
Schwenk, Achim
United Kingdom, London
North Middlesex University Hospital Nhs Trust
Miller, Sheila
United Kingdom, London
North Middlesex University Hospital Nhs Trust
Wood, Christopher W.
United Kingdom, London
North Middlesex University Hospital Nhs Trust
Wilson, Alan C.
United Kingdom, Edinburgh
Nhs Lothian
Morris, Sheila
United Kingdom, Edinburgh
Nhs Lothian
Gompels, Mark M.
United Kingdom, Bristol
North Bristol Nhs Trust
Allan, Sue
United Kingdom, Bristol
North Bristol Nhs Trust
Memon, Khurram
United Kingdom, Leicester
University Hospitals of Leicester Nhs Trust
Lewszuk, Adam Jacek
United Kingdom, Leicester
University Hospitals of Leicester Nhs Trust
Chadwick, David Robert
United Kingdom, Middlesbrough
South Tees Hospitals Nhs Foundation Trust
Gibson, Jane
United Kingdom, Middlesbrough
South Tees Hospitals Nhs Foundation Trust
Main, Paul
United Kingdom, London
Lewisham and Greenwich Nhs Trust
Dhillon, Mandip
United Kingdom, London
St George's University Hospitals Nhs Foundation Trust
Martin, Fabiola
United Kingdom, York
York Teaching Hospital Nhs Foundation Trust
Russell-Sharpe, Sarah
United Kingdom, York
York Teaching Hospital Nhs Foundation Trust
Allan, Sris P.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Harte, Andrew
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Clay, Stephen
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Tariq, Anjum
United Kingdom, Wolverhampton
The Royal Wolverhampton Nhs Trust
Spencer, Hazel
United Kingdom, Wolverhampton
The Royal Wolverhampton Nhs Trust
Jones, Ron
United Kingdom, Wolverhampton
The Royal Wolverhampton Nhs Trust
Pritchard, Jillian
United Kingdom, Chertsey
Ashford and st Peter's Hospitals Nhs Foundation Trust
Cumming, Shirley
United Kingdom, Chertsey
Ashford and st Peter's Hospitals Nhs Foundation Trust
Atkinson, Claire E.
United Kingdom, Chertsey
Ashford and st Peter's Hospitals Nhs Foundation Trust
Delpech, Valerie C.
United Kingdom, London
Public Health England
Aitken, Celia
United Kingdom, Glasgow
Gartnavel General Hospital
Asboe, David
United Kingdom, London
Chelsea and Westminster Hospital
Pozniak, Anton Louis
United Kingdom, London
Chelsea and Westminster Hospital
Churchill, Duncan R.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Clark, Duncan A.
United Kingdom, Wakefield
Nhs England
Collins, Simon
United Kingdom, London
Hiv I-base
Douthwaite, Sam Thomas
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Fearnhill, Esther
United Kingdom, London
University College London
Porter, Kholoud
United Kingdom, London
University College London
Tostevin, Anna
United Kingdom, London
University College London
White, Ellen
United Kingdom, London
University College London
Fraser, Christophe
United Kingdom, London
Imperial College London
Hale, Antony D.
United Kingdom, Leeds
Leeds Teaching Hospitals Nhs Trust
Hué, Stéphane
United Kingdom, London
University College London
Kaye, Steve
United Kingdom, London
Imperial College London
Kellam, P.
United Kingdom, Hinxton
Wellcome Sanger Institute
Lazarus, Linda
United Kingdom, London
Public Health England
Leigh Brown, Andrew J.
United Kingdom, Edinburgh
The University of Edinburgh
Mbisa, Tamyo
United Kingdom, London
Public Health England
Moses, Samuel E.
United Kingdom, London
King's College Hospital
Orkin, Chloe
United Kingdom, London
St Bartholomew's Hospital
Nastouli, Eleni
United Kingdom, London
Ucl Medical School
Morris, Lynn G.
United Kingdom, London
Ucl Medical School
Smit, Erasmus J.
United Kingdom, London
Public Health England
United Kingdom, Birmingham
Heartlands Hospital
Templeton, Kate E.
United Kingdom, Edinburgh
Royal Infirmary of Edinburgh
Tilston, Peter
United Kingdom, Manchester
Manchester Royal Infirmary
Webster, Daniel Peter
United Kingdom, London
Royal Free London Nhs Foundation Trust
Williams, Ian G.
United Kingdom, London
University College London
Zhang, Hongyi
United Kingdom, Cambridge
Addenbrooke's Hospital
Greatorex, Jane S.
United Kingdom, Cambridge
Addenbrooke's Hospital
O'Shea, Siobhan
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Mullen, Jane E.
United Kingdom, London
Guy's and st Thomas' Nhs Foundation Trust
Cox, Alison
United Kingdom, London
Imperial College Healthcare Nhs Trust
Tandy, Richard
United Kingdom, London
King's College Hospital
Fawcett, Tracy
United Kingdom, Leeds
Leeds Teaching Hospitals Nhs Trust
Hopkins, Mark J.
Unknown Affiliation
Ashton, Lynne J.
Unknown Affiliation
Booth, Clare L.
United Kingdom, London
The Royal Free Hospital
Garcia-Diaz, Ana M.
United Kingdom, London
The Royal Free Hospital
Shepherd, Jill A.
United Kingdom, Edinburgh
Royal Infirmary of Edinburgh
Schmid, Matthias Ludwig
United Kingdom, Newcastle
Royal Victoria Infirmary
Payne, Brendan Alexander Ingelby
United Kingdom, Newcastle
Royal Victoria Infirmary
Pereira, Spiro
United Kingdom, Wakefield
Nhs England
Hubb, Jonathan
United Kingdom, Wakefield
Nhs England
Kirk, Stuart
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
Gunson, Rory N.
Unknown Affiliation
Bradley-Stewart, Amanda J.
Unknown Affiliation
Statistics
Citations: 5
Authors: 134
Affiliations: 41
Identifiers
Doi:
10.1111/hiv.12302
ISSN:
14642662
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study