Factors predicting discordant virological and immunological responses to antiretroviral therapy in HIV-1 clade C infected zulu/xhosa in South Africa

Boris Julg, Danielle Poole, Musie Ghebremichael, Carmen Castilla, Marcus Altfeld, Henry Sunpath, Richard A. Murphy, Bruce D. Walker

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numbere31161
JournalPLoS One
Volume7
Issue number2
DOIs
StatePublished - Feb 14 2012
Externally publishedYes

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South Africa
Human immunodeficiency virus 1
HIV-1
immune response
Recovery
therapeutics
Hemoglobins
CD4 Lymphocyte Count
cells
Coinfection
Logistics
Body Mass Index
Therapeutics
HIV
mixed infection
body mass index
hemoglobin
Opportunistic Infections
Highly Active Antiretroviral Therapy
risk factors

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Factors predicting discordant virological and immunological responses to antiretroviral therapy in HIV-1 clade C infected zulu/xhosa in South Africa. / Julg, Boris; Poole, Danielle; Ghebremichael, Musie; Castilla, Carmen; Altfeld, Marcus; Sunpath, Henry; Murphy, Richard A.; Walker, Bruce D.

In: PLoS One, Vol. 7, No. 2, e31161, 14.02.2012.

Research output: Contribution to journalArticle

Julg, Boris ; Poole, Danielle ; Ghebremichael, Musie ; Castilla, Carmen ; Altfeld, Marcus ; Sunpath, Henry ; Murphy, Richard A. ; Walker, Bruce D. / Factors predicting discordant virological and immunological responses to antiretroviral therapy in HIV-1 clade C infected zulu/xhosa in South Africa. In: PLoS One. 2012 ; Vol. 7, No. 2.
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