JAC Advance Access originally published online on June 16, 2004
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Journal of Antimicrobial Chemotherapy 2004 54(2):503-507; doi:10.1093/jac/dkh329
JAC vol.54 no.2 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved.
A comparison of the CD4 response to antiretroviral regimens in patients commencing therapy with low CD4 counts
St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
* Corresponding author. Tel: +44-20-8746-8000; Fax: +44-20-8746-5611; Email: laura.waters{at}chelwest.nhs.uk
Objective: To compare the immunological response to highly active antiretroviral therapy (HAART) in treatment-naive patients with a baseline CD4 count of <200 cells/mm3.
Design and methods: We identified treatment-naive human immunodeficiency virus (HIV-1)-infected individuals who had commenced HAART since 1996 and who had a starting CD4 count of <200 cells/mm3. Immunological success was defined as achieving a CD4 count of >200 cells/mm3 and treatments were compared using univariate and multivariate Cox's proportional hazards models in order to establish whether protease inhibitor (PI)-based regimens were significantly different to regimens based on non-nucleoside reverse transcriptase inhibitors (NNRTIs). Both regimens utilize a nucleoside analogue (NA) backbone.
Results: A total of 599 patients were identified. When the variables were entered into a multivariate analysis, no significant differences between HAART regimens were found. We showed that compared with efavirenz regimens a two NA plus one PI regimen was not significantly less likely to achieve immunological success (adjusted HR: 0.65, 95% CI 0.41–1.03, P=0.07). Two NA and boosted PI (adjusted HR: 1.33, 95% CI 0.81 to 2.16) or two NA and nevirapine (adjusted HR: 0.93, 95% CI 0.67–1.29) regimens were also not significantly different from efavirenz-based regimens, based on the endpoint of immunological success.
Conclusion: PI-, boosted PI- and NNRTI-based HAART regimens are not significantly different in achieving increased CD4 counts in individuals who commence therapy with a low CD4 count.
Keywords: HAART , immune , PI , NNRTI , boosted
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