Objective: To compare the lymphocyte T CD4+ (CD4) response to combinations of antiretroviral therapy (ART) in HIV-1, HIV-2 and dually positive patients in West Africa.
Design and setting: Collaboration of 12 prospective cohorts of HIV-infected adults followed in Senegal (2), Gambia (1), Mali (2), Benin (1) and Côte d'Ivoire (6).
Subjects: Nine thousand, four hundred and eighty-two patients infected by HIV-1 only, 270 by HIV-2 only and 321 dually positive, who initiated an ART.
Outcome measures: CD4 change over a 12-month period.
Results: Observed CD4 cell counts at treatment initiation were similar in the three groups [overall median 155, interquartile range (IQR) 68; 249 cells/μl). In HIV-1 patients, the most common ART regimen was two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI; N = 7714) as well as for dually positive patients (N = 135). HIV-2 patients were most often treated with a protease inhibitor-based regimen (N = 193) but 45 of them were treated with an NNRTI-containing ART. In those treated with a NNRTI-containing regimen, the estimated mean CD4 change between 3 and 12 months was significantly lower in HIV-2 (−41 cells/μl per year) and dually positive patients (+12 cells/μl per year) compared to HIV-1 patients (+69 cells/μl per year, overall P value 0.01). The response in HIV-2 and dually positive patients treated by another regimen (triple NRTIs or protease inhibitor-containing ART) was not significantly different than the response obtained in HIV-1-only patients (all P values >0.30).
Conclusion: An optimal CD4 response to ART in West Africa requires determining HIV type prior to initiation of antiretroviral drugs. NNRTIs are the mainstay of first-line ART in West Africa but are not adapted to the treatment of HIV-2 and dually positive patients.
aINSERM U897, France
bUniversité Victor Segalen Bordeaux 2, ISPED, Bordeaux, France
cService de Maladies Infectieuses et Tropicales (SMIT), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d'Ivoire
dService d'Hépato-Gastro-Entérologie, Hôpital Gabriel Touré, Bamako, Mali
eCentre de Prise en Charge des personnes vivant avec le VIH (PVVIH) du Centre Hospitalier Universitaire (CHNU), Cotonou, Bénin
fSMIT, CHU de Fann, Dakar, Senegal
gProgramme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire
hFajara Cohort, MRC, Banjul, Gambia.
Received 26 May, 2009
Revised 21 July, 2009
Accepted 11 January, 2010
Correspondence to Rodolphe Thiébaut, INSERM U897 Epidemiology and Biostatistics, ISPED, Université Victor Segalen Bordeaux 2, 146 Rue Leo Saignat 33076 Bordeaux, France. Tel: +33 5 57 57 45 21; fax: +33 5 56 24 00 81; e-mail: firstname.lastname@example.org