Document Detail


Evaluating immunologic response and clinical deterioration in treatment-naive patients initiating first-line therapies infected with HIV-1 CRF01_AE and subtype B.
MedLine Citation:
PMID:  23138836     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: HIV-1 group M viruses diverge 25%-35% in envelope, important for viral attachment during infection, and 10%-15% in the pol region, under selection pressure from common antiretrovirals. In Asia, subtypes B and CRF01_AE are common genotypes. Our objectives were to determine whether clinical, immunological, or virological treatment responses differed by genotype in treatment-naive patients initiating first-line therapy.
METHODS: Prospectively collected longitudinal data from patients in Thailand, Hong Kong, Malaysia, Japan, Taiwan, and South Korea were provided for analysis. Covariates included demographics, hepatitis B and C coinfections, baseline CD4 T lymphocyte count, and plasma HIV-1 RNA levels. Clinical deterioration (a new diagnosis of Centers for Disease Control and Prevention category B/AIDS-defining illness or death) was assessed by proportional hazards models. Surrogate endpoints were 12-month change in CD4 cell count and virologic suppression post therapy, evaluated by linear and logistic regression, respectively.
RESULTS: Of 1105 patients, 1036 (93.8%) infected with CRF01_AE or subtype B were eligible for inclusion in clinical deterioration analyses and contributed 1546.7 person-years of follow-up (median: 413 days, interquartile range: 169-672 days). Patients >40 years demonstrated smaller immunological increases (P = 0.002) and higher risk of clinical deterioration (hazard ratio = 2.17; P = 0.008). Patients with baseline CD4 cell counts >200 cells per microliter had lower risk of clinical deterioration (hazard ratio = 0.373; P = 0.003). A total of 532 patients (48.1% of eligible) had CD4 counts available at baseline and 12 months post therapy for inclusion in immunolgic analyses. Patients infected with subtype B had larger increases in CD4 counts at 12 months (P = 0.024). A total of 530 patients (48.0% of eligible) were included in virological analyses with no differences in response found between genotypes.
CONCLUSIONS: Results suggest that patients infected with CRF01_AE have reduced immunologic response to therapy at 12 months, compared with subtype B-infected counterparts. Clinical deterioration was associated with low baseline CD4 counts and older age. The lack of differences in virologic outcomes suggests that all patients have opportunities for virological suppression.
Authors:
Rebecca A Oyomopito; Patrick C K Li; Somnuek Sungkanuparph; Praphan Phanuphak; Kok Keng Tee; Thira Sirisanthana; Pacharee Kantipong; Shinichi Oka; Chris K C Lee; Adeeba Kamarulzaman; Jun Yong Choi; Annette H Sohn; Matthew Law; Yi-Ming A Chen;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  62     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-08-08     Completed Date:  2013-08-20     Revised Date:  2014-03-26    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  293-300     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
Adult
Antiretroviral Therapy, Highly Active*
Asia
CD4 Lymphocyte Count
Female
Genotype
HIV Infections / drug therapy*,  immunology,  virology
HIV-1 / classification,  genetics*
Humans
Logistic Models
Male
Middle Aged
Prospective Studies
RNA, Viral / blood
Grant Support
ID/Acronym/Agency:
U01 AI069907/AI/NIAID NIH HHS; U01AI069907/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/RNA, Viral
Investigator
Investigator/Affiliation:
A Kamarulzaman / ; A Kajindran / ; L Y Ong / ; C K C Lee / ; R David / ; B L H Sim / ; C V Mean / ; V Saphonn / ; K Vohith / ; E Yunihastuti / ; F J Zhang / ; H X Zhao / ; N Han / ; J Y Choi / ; S H Han / ; J M Kim / ; M Mustafa / ; N Nordin / ; Perempuan Zainab / ; N Kumarasamy / ; S Saghayam / ; C Ezhilarasi / ; O T Ng / ; A Chua / ; L S Lee / ; A Loh / ; P C K Li / ; M P Lee / ; K H Wong / ; P Kantipong / ; P Kambua / ; P Phanuphak / ; K Ruxrungtham / ; M Khongphattanayothin / ; S Sirivichayakul / ; R Ditangco / ; E Uy / ; R Bantique / ; R Kantor / ; S Oka / ; J Tanuma / ; T Nishijima / ; S Pujari / ; K Joshi / ; A Makane / ; S Sungkanuparph / ; S Kiertiburanakul / ; L Chumla / ; N Sanmeema / ; T P Merati / ; D N Wirawan / ; F Yuliana / ; T Sirisanthana / ; R Chaiwarith / ; W Kotarathititum / ; J Praparattanapan / ; T T Pham / ; D D Cuong / ; H L Ha / ; V K Nguyen / ; V H Bui / ; T T Cao / ; W Ratanasuwan / ; R Sriondee / ; Y M A Chen / ; W W Wong / ; Y J Chen / ; L H Kuo / ; Y T Lin / ; A H Sohn / ; N Durier / ; B Petersen / ; T Singtoroj / ; D A Cooper / ; M G Law / ; A Jiamsakul /
Comments/Corrections

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