{"id":2257,"date":"2007-09-03T15:52:34","date_gmt":"2007-09-03T15:52:34","guid":{"rendered":"http:\/\/moomango.co.uk\/htb\/?p=2257"},"modified":"2014-02-07T10:04:00","modified_gmt":"2014-02-07T10:04:00","slug":"cd4-increases-in-immunological-non-responders-despite-suppressive-therapy-following-switch-to-nuke-sparing-regimen-of-atzsqvr","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/2257","title":{"rendered":"CD4 increases in immunological non-responders despite suppressive therapy following switch to nuke-sparing regimen of ATZ\/SQV\/r"},"content":{"rendered":"

Simon Collins, HIV i-Base<\/strong><\/p>\n

Gerd F\u00e4tkenheuer and colleagues from University Hospital, Infectious Diseases, Cologne, presented a poster on CD4 recovery in 15 patients (11 men, 4 women) who switched to an RTI-sparing combination, after not achieving immunological benefit (CD4 remained <250 cells\/mm3<\/sup>) despite undetectable viral load for over 6 months. Original therapy was lopinavir\/r (n=10), nelfinavir (n=1), efavirenz (n=1); background nucleosides were AZT\/3TC (n=10), AZT\/abacavir (n=1) and AZT\/tenofovir (n=3).<\/strong><\/p>\n

Patients were switched to atazanavir (ATV,\u00a0300 mg QD), saquinavir (SQV, 1000 mg BID) and ritonavir (RTV, 100 mg QD) and followed for 48 weeks. T cell activation (CD38+HLA-DR+) on CD4+ and CD8+ T- cells were longitudinally (0, 24 and 48 weeks) determined and compared to good immunologic (IgR) responders with ART (n=10) and patients with high CD4+ T cells without ART (n=9).<\/p>\n

Baseline characteristics included median [IQR] CD4 count 197 cells\/mm3<\/sup> [130-220]; months on ART 20 [6-114]; and age 46 years [38-62].<\/p>\n

Median CD4 cell count (and CD4 percentage) improved significantly to 230 cells\/mm3<\/sup> (14%), [170-290, 10-17%] and 260 cells\/mm3<\/sup> 17% [195-415, 13.5-18.5%] at weeks 24 and 48 respectively. Only one patient discontinued the study. Viral load remained < 50 copies\/mL in the remaining 14 patients.<\/p>\n

Activation markers did not change longitudinally or in comparison to IgR. Subjects with detectable HIV-RNA and high CD4+ T- cells demonstrated higher expression of CD38 on CD4+ and CD8+ T cells and HLA-DR on CD8+ T cells (p<0.05).<\/p>\n

Comment<\/h3>\n

Although this is small, uncontrolled study, in patients who fail to show a CD4 response on recommended first-line regimens, this option may deserve further exploration. <\/strong><\/p>\n

In the symposium on HIV pathogenesis on the first day of the conference, Michael Lederman referenced a study showing that up to 20% patients fail to achieve CD4 increase to greater than 350 cells\/mm3 after five years of suppressive therapy (below 95th percentile of HIV negative population).<\/strong> [2]<\/p>\n

References:<\/p>\n

    \n
  1. Lehmann C, Hofmann A, F\u00e4tkenheuer G et al. Recovery of CD4+ T cells after switch to a nucleoside free regimen in patients with poor immunologic response despite complete HIV-RNA suppression. 4th IAS conference, Sydney, 2007. Abstract WEPEB043.
    \nhttp:\/\/www.ias2007.org\/pag\/Abstracts.aspx?AID=1834<\/a><\/li>\n
  2. Lederman M. How HIV makes you sick: mechanisms of CD4+ T cell loss and recovery. 4th IAS conference, Sydney, 2007. Abstract MOPL102.
    \n    http:\/\/www.ias2007.org\/pag\/PSession.aspx?s=22<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Gerd F\u00e4tkenheuer and colleagues from University Hospital, Infectious Diseases, Cologne, presented a poster on CD4 recovery in 15 patients (11 men, 4 women) who switched to an RTI-sparing combination, after not achieving immunological benefit (CD4 remained …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,41],"tags":[92],"class_list":["post-2257","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-treatment-strategies","tag-ias-4th-2007"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/2257","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=2257"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/2257\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=2257"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=2257"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=2257"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}