Long-term CD4+ T-cell count evolution after switching from regimens including HIV nucleoside reverse transcriptase inhibitors (NRTI) plus protease inhibitors to regimens containing NRTI plus non-NRTI or only NRTIcontaining NRTI plus non-NRTI or only NRTI

Estimados colegas aquí les dejo un nuevo artículo sobre el tratamiento de VIH/Sida.

Saludos

Dr. Carlos Erazo

"Abstract
Background: Data regarding CD4+ recovery after switching from protease inhibitor (PI)-based
regimens to regimens not containing PI are scarce.
Methods: Subjects with virological success on first-PI-regimens who switched to NNRTI therapy
(NNRTI group) or to nucleoside reverse transcriptase (NRTI)-only (NRTI group) were studied. The
effect of the switch on the ongoing CD4+ trend was assessed by two-phase linear regression (TPLR),
allowing us to evaluate whether a change in the CD4+ trend (hinge) occurred and the time of its
occurrence. Furthermore, we described the evolution of the frequencies in CD4-count classes across
four relevant time-points (baseline, before and immediately after the switch, and last visit). Finally, we explored whether the CD4+ counts evolved differently in patients who switched to NNRTI or NRTI only regimens by considering: the overall CD4+ trends, the time to CD4+≥500/mm3 after the switch, and the area-under-the-curve (AUC) of the CD4+ after the switch.
Results: Eight hundred and ninety-six patients, followed for a median of 2,121 days, were included.
At TPLR, hinges occurred in 581/844 (68.9%), but in only 40/581 (6.9%) within a time interval (180
days) compatible with a possible relationship to the switch; furthermore, in 19/40 cases, CD4+ counts
appeared to decrease after the hinges. In comparison with the NNRTI group, the NRTI group showed
CD4+ count greater at baseline (P=0.0234) and before the switch (P≤0.0001), superior CD4+ T-cell
increases after HAART was started, lower probability of not achieving CD4+ ≥500/mm3 (P=0.0024),
and, finally, no significant differences in the CD4+ T-cell AUC after the switch after adjusting for
possible confounders (propensity score and pre-switch AUC). Persistence at CD4+ <200/mm3 was
observed in 34/435 (7.5%) patients, and a decrease below this level was found in only 10/259 (3.9%)
with baseline CD4+ ≥350/mm3.
Conclusions: Switching from first-line PI to NNRTI- or NRTI-based regimens did not seem to impair
CD4+ trend over long-term follow-up. Although the greater CD4+ increases in patients who switched
to the NRTI-only regimen was due to higher CD4+ counts before the switch, several statistical
analyses consistently showed that switching to this regimen did not damage the ongoing immunereconstitution.
Lastly, the observation that CD4+ T-cell counts remained low or decreased in the long term despite virological success merits further investigation

http://www.biomedcentral.com/content/pdf/1471-2334-11-23.pdf