Clinical and laboratorial impact of antiretroviral therapy in a cohort of Portuguese patients chronically infected with HIV‐2

Introduction HIV‐2 infection is endemic in West Africa and some European countries, namely Portugal. HIV‐2 antiretroviral (ARV) treatment presents some restrains related to intrinsic resistance to non‐nucleoside reverse transcriptase inhibitors (NNRTI) and fusion inhibitors, and poorer response to protease inhibitors (PI). Material and Methods Retrospective observational study of a cohort of 135 infected HIV‐2 patients, diagnosed between 1989 and 2008. Objectives Evaluation of epidemiologic, clinical, immunologic and virologic progression, comparing to groups of patients (naïve vs ARV experienced); characterization of therapeutic, immunologic and virologic response. SPSS version 20.0 was used for statistical analysis. Results The study included 135 patients: 41% (n=55) naïve and 59% (n=80) with ARV experience. The comparison between groups (naïve vs ARV) revealed: male prevalence 76% vs 50%; mean age 54.5 years vs 54.8 (p=0.90); main geographic origin Guiné Bissau (47% vs 44%) and Portugal (22% vs 33%); and transmission mainly acquired by heterosexual contact (87% vs 80%). Mean time since diagnosis was 14 vs 13 years (p=0.31); 2% vs 50% presented AIDS criteria at diagnosis (p<0.001) and 93% vs 38% registered TCD4>350 cell/mm 3 at diagnosis (p<0.001). Immunological evolution showed no significant decline in naïve population (Δ=−67 cell/mm 3 – p=0.18) and a significant recovery in ARV experienced (Δ=+207 cell/mm 3 – p<0.001). Global mortality rate found was 18% (6% vs 13% – p=0.122). Eighty patients initiated ARV: 84% presented a time interval of ARV exposure between 0–5 years (42%) and 5–10 years (42%). Fifty percent experienced ≤2 ARV regimens and the remaining >2 regimes. Considering the first ARV therapy: 56% initiated PI, 30% NTRI and 5% integrase inhibitor (II)‐based regimens. Currently, 54 patients maintain regular follow‐up and ARV therapy: 60% NTRI+PI; 37% NRTI+PI+II and 3% NRTI+II. TDF/FTC is the backbone in 56%. Most frequent PIs are LPV/r (54%), DRV/r (19%) and ATV/r (12%). Mean time of exposure to NRTI=3 years, PI=7 years and II=2 years. Immunologic recovery was sustained for each of the ARV class considered (NRTI Δ=+144 cell/mm 3 ; PI=Δ+92 cell/mm 3 ; II=Δ=+116 cell/mm 3 ). Conclusions This is a cohort accompanied for a long period and the majority of patients present extensive ARV experience. The ARV‐experienced patients registered a favourable response to treatment, with sustained immune recovery (Δ=+207 cell/mm 3 ) and virologic control in 74%. Immunologic behaviour evidenced a sustained gain for each of the ARV class considered.