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First-year lymphocyte T CD4+ response to antiretroviral therapy according to the HIV type in the IeDEA West Africa collaboration

Drylewicz, Juliaa,b; Eholie, Sergec; Maiga, Moussad; Zannou, Djimon Marcele; Sow, Papa Saliff; Ekouevi, Didier Ka,g; Peterson, Kevinh; Bissagnene, Emmanuelc; Dabis, Françoisa,b; Thiébaut, Rodolphea,b; for the International epidemiologic Databases to Evaluate AIDS (IeDEA) West Africa Collaboration

doi: 10.1097/QAD.0b013e3283377a06
Epidemiology and Social

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: rodolphe.thiebaut@isped.u-bordeaux2.fr

© 2010 Lippincott Williams & Wilkins, Inc.