Better virological outcomes amongst people living with HIV initiating early antiretroviral treatment (CD4 counts ≥ 500 cells/µL) in the HPTN 071 (PopART) trial in South Africa
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
BACKGROUND: There have been concerns about reduced adherence and HIV virological suppression (VS) amongst clinically well people living with HIV initiating antiretroviral treatment (ART) with high pre-ART CD4 cell counts. We compared virological outcomes by pre-ART CD4 count, where universal ART initiation was provided in the HPTN 071 (PopART) trial in South Africa prior to routine national and international implementation. METHODS: This prospective cohort study included adults initiating ART at facilities providing ART irrespective of CD4 count since January 2014. VS (<400 copies/ml), confirmed virological failure (VF) (two consecutive viral loads>1000 copies/ml) and viral rebound were compared between participants in strata of baseline CD4 count. RESULTS: The sample included 1901 participants. VS was 94% or greater amongst participants with baseline CD4 count ≥500 cells/µL at all six-monthly intervals to 30 months of ART. The risk of an elevated viral load (≥400 copies/ml) was independently lower amongst participants with baseline CD4 count ≥500 cells/µL (3.3%) compared to those with CD4 count 200-499 cell/µL (9.2%) between months 18-30, adjusted relative risk=0.30 (95% CI: 0.12-0.74, P=0.010). The incidence rate of VF was 7.0, 2.0 and 0.5 per 100 person-years amongst participants with baseline CD4 count <200, 200-499 and ≥500 cells/µL, respectively (P<0.0001). VF was independently lower amongst participants with baseline CD4 count ≥500 cells/µL, adjusted hazard ratio (aHR)=0.23, P=0.045; and three-fold higher amongst those with baseline CD4 count <200 cells/µL, aHR=3.49, P<0.0001. CONCLUSION: Despite previous concerns, participants initiating ART with CD4 counts ≥500 cells/µL had very good virological outcomes, being better than those with CD4 counts 200-499 cells/µL.
Date Issued
2020-02-01
Date Acceptance
2019-03-13
Citation
Clinical Infectious Diseases, 2020, 70 (3), pp.395-403
ISSN
1058-4838
Publisher
Oxford University Press (OUP)
Start Page
395
End Page
403
Journal / Book Title
Clinical Infectious Diseases
Volume
70
Issue
3
Copyright Statement
© 2019 American Chemical Society. This is an open access article published under an ACS AuthorChoice License, which permits copying and redistribution of the article or any adaptations for non-commercial purposes.
Sponsor
National Institutes of Health
Imperial College Healthcare NHS Trust- BRC Funding
National Institutes of Health
Medical Research Council (MRC)
National Institutes of Health
National Institutes of Health
Department for International Development (UK) (DFI
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30877753
PII: 5381973
Grant Number
5 U19 AI 067854-04
RDA02 79560
EPIDVH72
MR/L00528X/1
HPTN071 Substudy:Phylo PopART
PO15001410 (UMIAI068619)
N/A
RDA02
Subjects
HIV/AIDS
HPTN 071 (PopART) Trial
baseline CD4 cell count
early antiretroviral treatment
virological outcomes
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-03-16