| Title: |
Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation |
| Authors: |
Jose, S.; Quinn, K.; Dunn, D.; Cox, A.; Sabin, C.; Fidler, S.; Fisher, Martin; Gazzard, Brian; Gilson, Richard; Gompels, Mark; Hay, Phillip; Johnson, Margaret; Kegg, Stephen; Leen, Clifford; Martin, Fabiola; Nelson, Mark; Palfreeman, Adrian; Post, Frank; Pritchard, Jillian; Sachikonye, Memory; Schwenk, Achim; Tariq, Anjum; Walsh, John; Hill, Teresa; Jose, Sophie; Phillips, Andrew; Sabin, Caroline; Thornton, Alicia; Dunn, David; Glabay, Adam; Fisher, M. |
| Publisher Information: |
Wiley-Blackwell Publishing |
| Publication Year: |
2016 |
| Collection: |
The University of Queensland: UQ eSpace |
| Subject Terms: |
Antiretroviral therapy; CD4 count; HIV resistance; Virological failure; 2719 Health Policy; 2725 Infectious Diseases; 2736 Pharmacology (medical) |
| Description: |
Objectives: No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy (cART) at CD4 counts > 350 cells/μL. It is hypothesized that earlier initiation of cART in asymptomatic and otherwise healthy individuals may lead to poorer adherence and subsequently higher rates of resistance development. Methods: In a large cohort of HIV-positive individuals, we investigated the emergence of new resistance mutations upon virological treatment failure according to the CD4 count at the initiation of cART. Results: Of 7918 included individuals, 6514 (82.3%), 996 (12.6%) and 408 (5.2%) started cART with a CD4 count ≤ 350, 351-499 and ≥ 500 cells/μL, respectively. Virological rebound occurred while on cART in 488 (7.5%), 46 (4.6%) and 30 (7.4%) with a baseline CD4 count ≤ 350, 351-499 and ≥ 500 cells/μL, respectively. Only four (13.0%) individuals with a baseline CD4 count > 350 cells/μL in receipt of a resistance test at viral load rebound were found to have developed new resistance mutations. This compared to 107 (41.2%) of those with virological failure who had initiated cART with a CD4 count < 350 cells/μL. Conclusions: We found no evidence of increased rates of resistance development when cART was initiated at CD4 counts above 350 cells/μL. HIV Medicine |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| ISSN: |
1468-1293; 1464-2662 |
| Relation: |
orcid:0000-0003-4487-8803; G0000199 %7C G0900274 %7C M004236 %7C G0600337 |
| Availability: |
https://espace.library.uq.edu.au/view/UQ:774bf90 |
| Accession Number: |
edsbas.141BA9A |
| Database: |
BASE |