- Oral presentation
- Open Access
O212 Rate of change in CD4 counts in patients with stable HIV viremia
© Phillips et al; licensee BioMed Central Ltd. 2008
- Published: 10 November 2008
- Viral Load
- cART Regimen
- O212 Rate
- Current cART
- Triple Nucleoside
The majority of patients currently treated with cART live in resource-limited settings and many patients are left on a virologically failing regimen, typically an NNRTI-containing regimen. The aim was therefore to identify the level of viremia at which CD4 counts significantly decrease in patients on cART and the factors, including regimen type, associated with CD4 count changes.
Annual CD4 slopes were calculated from three consecutive CD4 measurements whilst the viral load was stable, defined as <0.5 log10 copies/ml difference between the highest and lowest viral loads measured at the same three time-points. Generalised linear models, with adjustment for repeated measurements within patients, were used to model CD4 slopes.
Among patients on cART, adjusting for relevant confounders, patients on a single PI-based cART regimen (mean CD4 slope [SE] 43.3/mm3 [2.4]) or a ritonavir-boosted PI (46.9/mm3 [2.3]) had more positive CD4 slopes compared to patients taking a non-nucleoside reverse-transcriptase inhibitor (31.1/mm3 [1.7]) or a triple nucleoside regimen (30.2/mm3 [4.0], p < 0.0001).
The results from our study would suggest that some treatment with cART is better than none, but also that better CD4 count increases are obtained by using a PI or ritonavir-boosted PI-based regimen than by using an NNRTI-based regimen. Patients were not randomised to treatment and confounding by indication cannot be ruled out. Patients with stable viremia unable to fully suppress HIV replication should continue therapy and consideration should be given to the use of a PI-based regimen.
This article is published under license to BioMed Central Ltd.