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Lookup NU author(s): Dr Matthias Schmid, Dr Brendan PayneORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2016 British HIV Association. Objectives: No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy (cART) at CD4 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 CD4 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 CD4 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 CD4 count ≤ 350, 351-499 and ≥ 500 cells/μL, respectively. Only four (13.0%) individuals with a baseline CD4 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 CD4 count < 350 cells/μL. Conclusions: We found no evidence of increased rates of resistance development when cART was initiated at CD4 counts above 350 cells/μL. HIV Medicine
Author(s): Jose S, Quinn K, Dunn D, Cox A, Sabin C, Fidler S, Fisher M, Gazzard B, Gilson R, Gompels M, Hay P, Johnson M, Kegg S, Leen C, Martin F, Nelson M, Palfreeman A, Post F, Pritchard J, Sachikonye M, Schwenk A, Tariq A, Walsh J, Hill T, Jose S, Phillips A, Sabin C, Thornton A, Dunn D, Glabay A, Fisher M, Perry N, Tilbury S, Youssef E, Churchill D, Gazzard B, Nelson M, Everett R, Asboe D, Mandalia S, Post F, Korat H, Taylor C, Gleisner Z, Ibrahim F, Campbell L, Gilson R, Brima N, Williams I, Johnson M, Youle M, Lampe F, Smith C, Tsintas R, Chaloner C, Hutchinson S, Phillips A, Hill T, Thornton A, Huntington S, Walsh J, Mackie N, Winston A, Weber J, Ramzan F, Carder M, Orkin C, Lynch J, Hand J, de Souza C, Anderson J, Munshi S, Ainsworth J, Schwenk A, Miller S, Wood C, Leen C, Wilson A, Morris S, Gompels M, Allan S, Palfreeman A, Memon K, Lewszuk A, Chadwick D, Cope E, Gibson J, Kegg S, Main P, Mitchell, Hunter, Hay P, Dhillon M, Martin F, Russell-Sharpe S, Allan S, Harte A, Clay S, Tariq A, Spencer H, Jones R, Pritchard J, Cumming S, Atkinson C, Delpech V, Sachikony M, Aitken C, Asboe D, Pozniak A, Cane P, Chadwick D, Churchill D, Clark D, Collins S, Delpech V, Douthwaite S, Fearnhill E, Porter K, Tostevin A, White E, Fraser C, Geretti AM, Hale A, Hue S, Kaye S, Kellam P, Lazarus L, Leigh-Brown A, Mbisa T, Mackie N, Moses S, Orkin C, Nastouli E, Pillay D, Smit E, Templeton K, Tilston P, Webster D, Williams I, Zhang H, Greatorex J, O'Shea S, Mullen J, Cox A, Tandy R, Fawcett T, Hopkins M, Ashton L, Booth C, Garcia-Diaz A, Shepherd J, Schmid ML, Payne B, Pereira S, Hubb J, Kirk S, Gunson R, Bradley-Stewart A
Publication type: Article
Publication status: Published
Journal: HIV Medicine
Year: 2016
Volume: 17
Issue: 5
Pages: 368-372
Print publication date: 01/05/2016
Online publication date: 25/08/2015
Acceptance date: 01/07/2015
Date deposited: 03/04/2017
ISSN (print): 1464-2662
ISSN (electronic): 1468-1293
Publisher: Blackwell Publishing Ltd
URL: http://dx.doi.org/10.1111/hiv.12302
DOI: 10.1111/hiv.12302
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