RT Journal Article
T1 Late presentation for HIV impairs immunological but not virological response to antiretroviral treatment
A1 Rava, Marta
A1 Bisbal, Otilia
A1 Domínguez Domínguez, Lourdes
A1 Aleman, María Remedios
A1 Rivero, María
A1 Antela, Antonio
A1 Estrada Pérez, Vicente
A1 Ribera, Esteban
A1 Muñoz, Adolfo
A1 Iribarren, José Antonio
A1 Moreno, Santiago
A1 Rubio García, Rafael
A1 Jarrín, Inmaculada
AB Objectives: The aim of this study was to examine the impact of late presentation (CD4+ cell count <350 cells/μl or an AIDS-defining event) on effectiveness and safety of initial antiretroviral therapy (ART) and to evaluate whether treatment response depends on first-line ART regimen in late presenters.Design: ART-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting triple ART between 2010 and 2018.Methods: We used multivariable models to assess differences in viral suppression (viral load <50 copies/ml), immunological response (change in CD4+ cell count, CD4% (>29%) and CD4/CD8 normalization (>0.4 and >1) multiple T-cell marker recovery (MTMR): CD4+ cell count more than 500 cells/μl and CD4% >29% and CD4/CD8 >1), and treatment discontinuation due to adverse events (TDAE) at 48 weeks from ART initiation.Results: Out of 8002 participants, 48.7% were late presenters. Of them, 45.8% initiated ART with a NNRTI- (mostly TDF/FTC/EFV), 33.9% with a protease inhibitor (mostly TDF/FTC+boosted DRV) and 20.3% with an INI-based regimen (mostly ABC/3TC/DTG). At 48 weeks, late presenters had similar viral suppression, but worse immunological response, than non-late presenters with no difference on TDAE. Late presenters initiating with NNRTI-based regimens were more likely to achieve viral suppression than those starting with INI-based, due to the higher chance of achieving viral suppression observed with TDF/FTC/RPV compared to ABC/3TC/DTG. Initial treatment with NNRTI or protease inhibitor based showed similar immunological response than the INI-based regimens, which showed lower rates of TDAE than NNRTI- and protease inhibitor based regimens.Conclusion: Despite safety and effectiveness of initial ART in terms of viral suppression, late presenters may not experience complete immunological response. In late presenters, effectiveness and safety depends on both the class and the specific first-line ART regimen.
PB Lippincott, Williams & Wilkins
YR 2021
FD 2021-07-01
LK https://hdl.handle.net/20.500.14352/105278
UL https://hdl.handle.net/20.500.14352/105278
LA eng
NO Rava M, Bisbal O, Domínguez-Domínguez L, Aleman MR, Rivero M, Antela A, Estrada V, Ribera E, Muñoz A, Iribarren JA, Moreno S, Rubio R, Jarrín I; Cohort of the Spanish HIV/AIDS Research Network (CoRIS). Late presentation for HIV impairs immunological but not virological response to antiretroviral treatment. AIDS. 2021 Jul 1;35(8):1283-1293
NO Instituto de Salud Carlos III
NO Comisión Europea
DS Docta Complutense
RD 5 abr 2025