Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Responses to highly active antiretroviral therapy and clinical events in patients with a low CD4 cell count: Late presenters vs. late starters
HIV Medicine, Volume 12, No. 5, Year 2011
Notification
URL copied to clipboard!
Description
Objective: We investigated whether adverse responses to highly active antiretroviral therapy (HAART) associated with late HIV presentation are secondary to low CD4 cell count per se or other confounding factors. Methods: A longitudinal analysis of the UK Collaborative HIV Cohort (CHIC) Study of individuals starting HAART in 1998-2007 was carried out, comparing late presenters (presenting/starting HAART at a CD4 count <200cells/μL) with late starters (presenting at a CD4 count>350cells/μL; starting HAART at a CD4 count<200cells/μL), using 'ideal starters' (presenting at a CD4 count>350cells/μL; starting HAART at a CD4 count of 200-350cells/μL) as a comparator. Virological, immunological and clinical (new AIDS event/death) outcomes at 48 and 96 weeks were analysed, with the analysis being limited to those remaining on HAART for>3 months. Results A total of 4978 of 9095 individuals starting first-line HAART with HIV RNA>500 HIV-1 RNA copies/mL were included in the analysis: 2741 late presenters, 947 late starters and 1290 ideal starters. Late presenters were more commonly female, heterosexual and Black African. Most started nonnucleoside reverse transcriptase inhibitors (NNRTIs); 48-week virological suppression was similar in late presenters and starters (and marginally lower than in ideal starters); by week 96 differences were reduced and nonsignificant. The median CD4 cell count increase in late presenters was significantly lower than that in late starters (weeks 48 and 96). During year 1, new clinical events were more frequent for late presenters [odds ratio (OR) 2.04; 95% confidence interval (CI) 1.19-3.51; P=0.01]; by year 2, event rates were similar in all groups. Conclusion Amongst patients who initiate, and remain on, HAART, late presentation is associated with lower rates of virological suppression, blunted CD4 cell count increases and more clinical events compared with late starters in year 1, but similar clinical and immunological outcomes by year 2 to those of both late and ideal starters. Differences between late presenters and late starters suggest that factors other than CD4 cell count alone may be driving adverse treatment outcomes in late-presenting individuals. © 2010 British HIV Association.
Authors & Co-Authors
Waters, Laura Jane
United Kingdom, London
Chelsea and Westminster Hospital
Fisher, Martin J.
United Kingdom, Worthing
University Hospitals Sussex Nhs Foundation Trust
Anderson, Jane
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Wood, Christopher W.
United Kingdom, London
North Middlesex University Hospital
Delpech, Valerie C.
United Kingdom, London
Public Health England
Hill, Teresa
United Kingdom, London
Royal Free London Nhs Foundation Trust
Walsh, John Christopher
United Kingdom, London
St Mary's Hospital
Orkin, Chloë M.
United Kingdom, London
Barts Health Nhs Trust
Bansi-Matharu, Loveleen K.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Gompels, Mark M.
United Kingdom, Bristol
North Bristol Nhs Trust
Phillips, Andrew N.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Johnson, Margaret A.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Gilson, Richard John Cary
United Kingdom, London
Royal Free London Nhs Foundation Trust
Easterbrook, Philippa Jane
United Kingdom, London
King's College Hospital
Leen, Clifford L.S.
United Kingdom, Edinburgh
Nhs Lothian
Porter, Kholoud
United Kingdom, London
Medical Research Council
Gazzard, Brian George L.
United Kingdom, London
Chelsea and Westminster Hospital
Sabin, Caroline Anne
United Kingdom, London
Royal Free London Nhs Foundation Trust
Statistics
Citations: 29
Authors: 18
Affiliations: 12
Identifiers
Doi:
10.1111/j.1468-1293.2010.00881.x
ISSN:
14681293
Research Areas
Infectious Diseases
Study Design
Cohort Study
Case-Control Study
Participants Gender
Female