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Abstract
QUANTIFYING 'PARADOXICAL' CD4 RESPONSES AMONG A CLOSELY FOLLOWED COHORT OF PATIENTS INITIATING ANTIRETROVIRAL THERAPY
WOOD E, YIP B, HOGG R, SHERLOCK C, HARRIGAN R, O'SHAUGHNESSY M, MONTANER J
Objective: We have characterized pVL and CD4 cell responses in a closely followed cohort of patients initiating triple drug therapy to evaluate determinants and prevalence of ‘discordant’ CD4 responses.
Methods: All patients, who were antiretroviral naïve and who initiated therapy between August 1996 and June 2000 were eligible. The only selection criteria was that patients had to have baseline CD4 and pVL measures at baseline, and at least once every 15 weeks after the initiation of therapy. We sought patients who had a ‘discordant’ response, defined as a gain in 50 cells/mm3 without a pVL measure below 1000 c/mL or a > 1 log decrease pVL. We also evaluated the median cumulative number of antiretrovirals used among Full Virological Responders (FVR: achieved and sustained a pVL < 500 c/mL), and Transient Virological Responders (TVR: achieved a pVL < 500 c/mL, but subsequently rebounded to > 500 c/mL at least once over the study).
Results: Overall, when baseline pVL and CD4 were compared to pVL/CD4 data at 12 months, 6.2% of patients appeared to have a CD4 response without a virological response. However, when all pVL measures prior to 12 months were considered, 92% of these discordant responses could be attributed to a transient > 1 log decrease in pVL or a pVL measure below 1000 copies/mL. By the 4th follow-up, FVR had a median increase of 170 cells/mm3 and TVR had a median increase of 130 cells/mm3. However, by this time TVR had already been exposed to a median of 4 antiretrovirals in comparison to FVR who had only been exposed to a median of 3. Divergent patterns of medication use persisted over the study period.
Conclusions: We find little evidence of a CD4 response, unrelated to pVL suppression after one year among treatment naïve patients. Unmeasured transient pVL suppression, medication switching/enhancement, and/or partial suppression among pre-treated patients, likely explain paradoxical CD4 responses that have been reported previously.
The 1st. IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
18
Suggested Citation
"WOODE, et al.
QUANTIFYING 'PARADOXICAL' CD4 RESPONSES AMONG A CLOSELY FOLLOWED COHORT OF PATIENTS INITIATING ANTIRETROVIRAL THERAPY.
Oral Presentation:
The 1st. IAS Conference on HIV Pathogenesis and Treatment
:
Abstract no.
18"
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