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Determinants of response to first HAART regimen in antiretroviral-naïve patients with an estimated time since HIV seroconversion

  1. R Thiébaut1,2,
  2. H Jacqmin-Gadda1,
  3. S Walker3,
  4. C Sabin4,
  5. M Prins5,
  6. J Del Amo6,
  7. K Porter3,
  8. F Dabis2,
  9. G Chêne2,
  10. the CASCADE Collaboration1

Article first published online: 24 NOV 2005

DOI: 10.1111/j.1468-1293.2005.00332.x

Issue

HIV Medicine

HIV Medicine

Volume 7, Issue 1, pages 1–9, January 2006

Additional Information

How to Cite

Thiébaut, R., Jacqmin-Gadda, H., Walker, S., Sabin, C., Prins, M., Del Amo, J., Porter, K., Dabis, F., Chêne, G. and the CASCADE Collaboration (2006), Determinants of response to first HAART regimen in antiretroviral-naïve patients with an estimated time since HIV seroconversion. HIV Medicine, 7: 1–9. doi: 10.1111/j.1468-1293.2005.00332.x

Author Information

  1. 1

    INSERM E0338 Biostatistics

  2. 2

    INSERM U593, ISPED, Bordeaux 2 University, Bordeaux, France,

  3. 3

    MRC Clinical Trials Unit, London, UK,

  4. 4

    Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College, London, UK,

  5. 5

    Municipal Health Service, Cluster Infectious Diseases, Amsterdam, the Netherlands, and

  6. 6

    Public Health Department, Miguel Hernández University, San Juan-Alicante, Spain

* Rodolphe Thiébaut, INSERM E0338 & U593 – ISPED, Université Bordeaux 2 – Victor Segalen, 146 Rue Léo Saignat, 33076 Bordeaux Cedex, France. Tel: (33) 5 57 57 45 21; fax: (33) 5 56 24 00 81; e-mail: rodolphe.thiebaut@isped.u-bordeaux2.fr

Publication History

  1. Issue published online: 24 NOV 2005
  2. Article first published online: 24 NOV 2005
  3. Received: 21 October 2004, accepted 29 March 2005

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Keywords:

  • CD4 T lymphocytes;
  • HIV infection;
  • HIV RNA;
  • longitudinal study;
  • seroconverters

Objective

To study the determinants of immunological and virological response to highly active antiretroviral therapy (HAART) in naïve patients, adjusting for time since HIV-1 seroconversion.

Design

Data from HIV-cohort studies where dates of seroconversion have been reliably estimated.

Methods

In previously untreated patients, short- and long-term marker responses from HAART initiation (three or more antiretroviral drugs) to the end of follow-up or any treatment modification were considered using mixed effects models accounting for undetectable HIV viral load and informative dropout.

Results

In total, 943 patients were treated with a first HAART regimen for a median of 29 months. In adjusted analyses, compared with a reference group of homosexual men without AIDS initiating treatment 4 years after seroconversion, injecting drug users (IDUs) were treated at similar CD4 and HIV RNA levels but had poorer short-term virological response (2.54 vs 2.13 log10 HIV-1 RNA copies/mL at 1.5 months, P=0.03) and poorer long-term immunological response (522 vs 631 cells/μL at 24 months, P<0.0001). Although individuals with AIDS at HAART initiation had lower CD4 counts (206 vs 382 cells/μL, P<0.0001), their immunological responses were similar to those of individuals without AIDS. Similarly, individuals further from seroconversion started HAART at lower CD4 counts (e.g. 311 vs 382 cells/μL at vs before 9 years from seroconversion, P<0.0001), but had similar CD4 responses. However, they experienced poorer long-term virological response (0.67 log10 copies/mL/year smaller decline, P<0.0001) compared to those treated before 9 years from seroconversion.

Conclusion

Taking into account the time elapsed since seroconversion, this study suggests that careful choices of initial treatment should be made and intensive follow-up carried out in high-risk subgroups such as IDUs who have poorer responses.

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