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Virological failure and development of new resistance mutations according to CD 4 count at combination antiretroviral therapy initiation
Author(s) -
Jose S,
Quinn K,
Dunn D,
Cox A,
Sabin C,
Fidler S
Publication year - 2016
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12302
Subject(s) - cart , medicine , viral load , antiretroviral therapy , asymptomatic , cohort , human immunodeficiency virus (hiv) , immunology , virology , mechanical engineering , engineering
Objectives No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy ( cART ) at CD 4 counts > 350 cells/μL. It is hypothesized that earlier initiation of cART in asymptomatic and otherwise healthy individuals may lead to poorer adherence and subsequently higher rates of resistance development. Methods In a large cohort of HIV ‐positive individuals, we investigated the emergence of new resistance mutations upon virological treatment failure according to the CD 4 count at the initiation of cART . Results Of 7918 included individuals, 6514 (82.3%), 996 (12.6%) and 408 (5.2%) started cART with a CD 4 count ≤ 350, 351–499 and ≥ 500 cells/μL, respectively. Virological rebound occurred while on cART in 488 (7.5%), 46 (4.6%) and 30 (7.4%) with a baseline CD 4 count ≤ 350, 351–499 and ≥ 500 cells/μL, respectively. Only four (13.0%) individuals with a baseline CD 4 count > 350 cells/μL in receipt of a resistance test at viral load rebound were found to have developed new resistance mutations. This compared to 107 (41.2%) of those with virological failure who had initiated cART with a CD 4 count < 350 cells/μL. Conclusions We found no evidence of increased rates of resistance development when cART was initiated at CD 4 counts above 350 cells/μL.