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Evaluating immunologic response and clinical deterioration in treatment-naïve patients initiating first-line therapies infected with HIV-1 CRF01_AE and subtype B

Authors
 Rebecca A. Oyomopito  ;  Patrick CK. Li  ;  Somnuek Sungkanuparph  ;  Praphan Phanuphak  ;  Kok Keng Tee  ;  Thira Sirisanthana  ;  Pacharee Kantipong  ;  Shinichi Oka  ;  Chris KC. Lee  ;  Adeeba Kamarulzaman  ;  Jun Yong Choi  ;  Annette H. Sohn  ;  Matthew Law  ;  Yi-Ming A. Chen 
Citation
 JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, Vol.62(3) : 293-300, 2013 
Journal Title
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
ISSN
 1525-4135 
Issue Date
2013
MeSH
Adult ; Antiretroviral Therapy, Highly Active* ; Asia ; CD4 Lymphocyte Count ; Female ; Genotype ; HIV Infections/drug therapy* ; HIV Infections/immunology ; HIV Infections/virology ; HIV-1/classification ; HIV-1/genetics* ; Humans ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; RNA, Viral/blood
Keywords
HIV-1 ; Asia ; genotype ; CRF01_AE ; subtype B
Abstract
BACKGROUND:
HIV-1 group M viruses diverge 25%-35% in envelope, important for viral attachment during infection, and 10%-15% in the pol region, under selection pressure from common antiretrovirals. In Asia, subtypes B and CRF01_AE are common genotypes. Our objectives were to determine whether clinical, immunological, or virological treatment responses differed by genotype in treatment-naive patients initiating first-line therapy.
METHODS:
Prospectively collected longitudinal data from patients in Thailand, Hong Kong, Malaysia, Japan, Taiwan, and South Korea were provided for analysis. Covariates included demographics, hepatitis B and C coinfections, baseline CD4 T lymphocyte count, and plasma HIV-1 RNA levels. Clinical deterioration (a new diagnosis of Centers for Disease Control and Prevention category B/AIDS-defining illness or death) was assessed by proportional hazards models. Surrogate endpoints were 12-month change in CD4 cell count and virologic suppression post therapy, evaluated by linear and logistic regression, respectively.
RESULTS:
Of 1105 patients, 1036 (93.8%) infected with CRF01_AE or subtype B were eligible for inclusion in clinical deterioration analyses and contributed 1546.7 person-years of follow-up (median: 413 days, interquartile range: 169-672 days). Patients >40 years demonstrated smaller immunological increases (P = 0.002) and higher risk of clinical deterioration (hazard ratio = 2.17; P = 0.008). Patients with baseline CD4 cell counts >200 cells per microliter had lower risk of clinical deterioration (hazard ratio = 0.373; P = 0.003). A total of 532 patients (48.1% of eligible) had CD4 counts available at baseline and 12 months post therapy for inclusion in immunolgic analyses. Patients infected with subtype B had larger increases in CD4 counts at 12 months (P = 0.024). A total of 530 patients (48.0% of eligible) were included in virological analyses with no differences in response found between genotypes.
CONCLUSIONS:
Results suggest that patients infected with CRF01_AE have reduced immunologic response to therapy at 12 months, compared with subtype B-infected counterparts. Clinical deterioration was associated with low baseline CD4 counts and older age. The lack of differences in virologic outcomes suggests that all patients have opportunities for virological suppression.
Files in This Item:
T201303252.pdf Download
DOI
10.1097/QAI.0b013e31827a2e8f
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87907
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