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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Impact of CD8
+
T-cell activation on CD4
+
T-cell recovery and mortality in HIV-infected Ugandans initiating antiretroviral therapy
AIDS, Volume 25, No. 17, Year 2011
Notification
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Description
OBJECTIVES:: To assess whether T-cell activation independently predicts the extent of CD4 T-cell recovery and mortality in HIV-infected Ugandans initiating antiretroviral therapy (ART). DESIGN:: Prospective cohort study. METHODS:: HIV-infected adults starting ART and achieving a plasma HIV RNA level (VL) less than 400 copies/ml by month 6 were sampled from the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort in Mbarara, Uganda. CD4 count, VL, and the percentage-activated (CD38HLA-DR) T cells were measured every 3 months. RESULTS:: Of 451 HIV-infected Ugandans starting ART, most were women (70%) with median pre-ART values: age, 34 years; CD4 count, 135 cells/μl; and VL, 5.1 log10 copies/ml. Of these, 93% achieved a VL less than 400 copies/ml by month 6 and were followed for a median of 24 months, with 8% lost to follow-up at 3 years. Higher pre-ART CD8 T-cell activation was associated with diminished CD4 recovery after year 1, after adjustment for pre-ART CD4 count, VL, and sex (P = 0.017). Thirty-four participants died, 15 after month 6. Each 10% point increase in activated CD8 T cells at month 6 of suppressive ART was associated with a 1.6-fold increased hazard of subsequent death after adjusting for pretherapy CD4 count (P = 0.048). CONCLUSIONS:: Higher pre-ART CD8 T-cell activation independently predicts slower CD4 T-cell recovery and higher persistent CD8 T-cell activation during ART-mediated viral suppression independently predicts increased mortality among HIV-infected Ugandans. Novel therapeutic strategies aimed at preventing or reversing immune activation during ART are needed in this setting. © 2011 Wolters Kluwer Health Lippincott Williams & Wilkins.
Authors & Co-Authors
Hunt, Peter W.
United States, San Francisco
University of California, San Francisco
Cao, Huyen L.
United States, San Francisco
University of California, San Francisco
Uganda, Kampala
Joint Clinical Research Center Uganda
Uganda
Ca Department of Health Services
Muzoora, Conrad K.
Uganda, Mbarara
Mbarara University of Science and Technology
Ssewanyana, Isaac
Uganda, Kampala
Joint Clinical Research Center Uganda
Bennett, John E.
United States, San Francisco
University of California, San Francisco
Emenyonu, Nneka I.
Uganda, Mbarara
Mbarara University of Science and Technology
United States, Boston
Massachusetts General Hospital
Kembabazi, Annet
Uganda, Mbarara
Mbarara University of Science and Technology
Neilands, Torsten B.
United States, San Francisco
University of California, San Francisco
Bangsberg, David R.
Uganda, Mbarara
Mbarara University of Science and Technology
United States, Boston
Massachusetts General Hospital
Deeks, Steven G.
United States, San Francisco
University of California, San Francisco
Martin, Jeffrey N.
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 221
Authors: 11
Affiliations: 5
Identifiers
Doi:
10.1097/QAD.0b013e32834c4ac1
e-ISSN:
14735571
Research Areas
Environmental
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Uganda
Participants Gender
Female