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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Factors predicting discordant virological and immunological responses to antiretroviral therapy in HIV-1 clade C infected zulu/xhosa in South Africa
PLoS ONE, Volume 7, No. 2, Article e31161, Year 2012
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Description
Factors predicting suboptimal CD4 cell recovery have been studied in HIV clade-B infected US and European populations. It is, however, uncertain to what extent these results are applicable to HIV clade-C infected African populations. Multivariate analysis using logistic regression and longitudinal analyses using mixed models were employed to assess the impact of age, gender, baseline CD4 cell count, hemoglobin, body mass index (BMI), tuberculosis and other opportunistic co-infections, and frequencies of regimen change on CD4 cell recovery at 12 and 30 months and on overtime change in CD4 cells among 442 virologically suppressed South Africans. Despite adequate virological response 37% (95% CI:32%-42%) and 83% (95% CI:79%-86%) of patients on antiretroviral therapy failed to restore CD4 cell counts ≥200 cells/mm 3 after 12 and ≥500 cells/mm 3 after 30 months, respectively, in this South African cohort. Critical risk factors for inadequate recovery were older age (p = 0.001) and nadir CD4 cell count at ART initiation (p&0.0001), while concurrent TB co-infection, BMI, baseline hemoglobin, gender and antiretroviral regimen were not significant risk factors. These data suggest that greater efforts are needed to identify and treat HAART-eligible patients prior to severe CD4 cell decline or achievement of advanced age. © 2012 Julg et al.
Authors & Co-Authors
Jülg, Boris Dominik
United States, Cambridge
Massachusetts Institute of Technology
South Africa, Durban
University of Kwazulu-natal
Poole, Danielle
United States, Cambridge
Massachusetts Institute of Technology
South Africa, Durban
University of Kwazulu-natal
Ghebremichael, Musie S.
United States, Cambridge
Massachusetts Institute of Technology
United States, Boston
Dana-farber Cancer Institute
Castilla, Carmen
United States, Newark
Rutgers Biomedical and Health Sciences
Altfeld, Marcus A.
United States, Cambridge
Massachusetts Institute of Technology
South Africa, Durban
University of Kwazulu-natal
Sunpath, Henry
South Africa, Durban
Mccord Hospital
Murphy, Richard A.
Switzerland, Geneva
Medecins Sans Frontieres
Walker, Bruce D.
United States, Cambridge
Massachusetts Institute of Technology
South Africa, Durban
University of Kwazulu-natal
United States, Chevy Chase
Howard Hughes Medical Institute
Statistics
Citations: 26
Authors: 8
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0031161
e-ISSN:
19326203
Research Areas
Infectious Diseases
Study Design
Cohort Study
Study Locations
South Africa