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Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation
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...
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| Formato: | Online Artículo Texto |
| Lenguaje: | English |
| Publicado: |
John Wiley and Sons Inc.
2015
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| Materias: | |
| Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949527/ https://www.ncbi.nlm.nih.gov/pubmed/26306942 http://dx.doi.org/10.1111/hiv.12302 |
| _version_ | 1782443445054341120 |
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| author | Jose, S Quinn, K Dunn, D Cox, A Sabin, C Fidler, S Ainsworth, Jonathan Allan, Sris Anderson, Jane Babiker, Abdel Chadwick, David Delpech, Valerie Fisher, Martin Gazzard, Brian Gilson, Richard Gompels, Mark Hay, Phillip Hill, Teresa Johnson, Margaret Kegg, Stephen Leen, Clifford Martin, Fabiola Nelson, Mark Orkin, Chloe Palfreeman, Adrian Phillips, Andrew Pillay, Deenan Post, Frank Pritchard, Jillian Sachikonye, Memory Schwenk, Achim Tariq, Anjum Walsh, John Thornton, Alicia Glabay, Adam Perry, N Tilbury, S Youssef, E Churchill, D Everett, R Asboe, D Mandalia, S Korat, H Taylor, C Gleisner, Z Ibrahim, F Campbell, L Brima, N Williams, I Youle, M Lampe, F Smith, C Tsintas, R Chaloner, C Hutchinson, S Huntington, S Mackie, N Winston, A Weber, J Ramzan, F Carder, M Lynch, J Hand, J Souza, C Munshi, S Miller, S Wood, C Wilson, A Morris, S Allan, S Palfreeman, A Memon, K ewszuk, A Chadwick, D Cope, E Gibson, J Kegg, S Main, P Mitchell, Dr Hunter, Dr Hay, P Dhillon, M Martin, F Russell‐Sharpe, S Harte, A Clay, S Tariq, A Spencer, H Jones, R Atkinson, C Delpech, V Sachikonye, M Aitken, Celia Pozniak, Anton Cane, Patricia Clark, Duncan Collins, Simon Douthwaite, Samuel White, Ellen Fraser, Christophe Geretti, Anna Maria Hale, Antony Hué, Stéphane Kaye, Steve Kellam, Paul Lazarus, Linda Leigh‐Brown, Andrew Mbisa, Tamyo Moses, Samuel Nastouli, Eleni Smit, Erasmus Templeton, Kate Tilston, Peter Webster, Daniel Zhang, Hongyi Greatorex, Jane Mullen, Jane Tandy, Richard Fawcett, Tracy Hopkins, Mark Ashton, Lynn Booth, Claire Garcia‐Diaz, Ana Shepherd, Jill Schmid, Matthias L Payne, Brendan Pere, Spiro Hubb, Jonathan Kirk, Stuart Gunson, Rory Bradley‐Stewart, Amanda |
| author_facet | Jose, S Quinn, K Dunn, D Cox, A Sabin, C Fidler, S Ainsworth, Jonathan Allan, Sris Anderson, Jane Babiker, Abdel Chadwick, David Delpech, Valerie Fisher, Martin Gazzard, Brian Gilson, Richard Gompels, Mark Hay, Phillip Hill, Teresa Johnson, Margaret Kegg, Stephen Leen, Clifford Martin, Fabiola Nelson, Mark Orkin, Chloe Palfreeman, Adrian Phillips, Andrew Pillay, Deenan Post, Frank Pritchard, Jillian Sachikonye, Memory Schwenk, Achim Tariq, Anjum Walsh, John Thornton, Alicia Glabay, Adam Perry, N Tilbury, S Youssef, E Churchill, D Everett, R Asboe, D Mandalia, S Korat, H Taylor, C Gleisner, Z Ibrahim, F Campbell, L Brima, N Williams, I Youle, M Lampe, F Smith, C Tsintas, R Chaloner, C Hutchinson, S Huntington, S Mackie, N Winston, A Weber, J Ramzan, F Carder, M Lynch, J Hand, J Souza, C Munshi, S Miller, S Wood, C Wilson, A Morris, S Allan, S Palfreeman, A Memon, K ewszuk, A Chadwick, D Cope, E Gibson, J Kegg, S Main, P Mitchell, Dr Hunter, Dr Hay, P Dhillon, M Martin, F Russell‐Sharpe, S Harte, A Clay, S Tariq, A Spencer, H Jones, R Atkinson, C Delpech, V Sachikonye, M Aitken, Celia Pozniak, Anton Cane, Patricia Clark, Duncan Collins, Simon Douthwaite, Samuel White, Ellen Fraser, Christophe Geretti, Anna Maria Hale, Antony Hué, Stéphane Kaye, Steve Kellam, Paul Lazarus, Linda Leigh‐Brown, Andrew Mbisa, Tamyo Moses, Samuel Nastouli, Eleni Smit, Erasmus Templeton, Kate Tilston, Peter Webster, Daniel Zhang, Hongyi Greatorex, Jane Mullen, Jane Tandy, Richard Fawcett, Tracy Hopkins, Mark Ashton, Lynn Booth, Claire Garcia‐Diaz, Ana Shepherd, Jill Schmid, Matthias L Payne, Brendan Pere, Spiro Hubb, Jonathan Kirk, Stuart Gunson, Rory Bradley‐Stewart, Amanda |
| author_sort | Jose, S |
| collection | PubMed |
| description | 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. |
| format | Online Article Text |
| id | pubmed-4949527 |
| institution | National Center for Biotechnology Information |
| language | English |
| publishDate | 2015 |
| publisher | John Wiley and Sons Inc. |
| record_format | MEDLINE/PubMed |
| spelling | pubmed-49495272016-07-28 Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation Jose, S Quinn, K Dunn, D Cox, A Sabin, C Fidler, S Ainsworth, Jonathan Allan, Sris Anderson, Jane Babiker, Abdel Chadwick, David Delpech, Valerie Fisher, Martin Gazzard, Brian Gilson, Richard Gompels, Mark Hay, Phillip Hill, Teresa Johnson, Margaret Kegg, Stephen Leen, Clifford Martin, Fabiola Nelson, Mark Orkin, Chloe Palfreeman, Adrian Phillips, Andrew Pillay, Deenan Post, Frank Pritchard, Jillian Sachikonye, Memory Schwenk, Achim Tariq, Anjum Walsh, John Thornton, Alicia Glabay, Adam Perry, N Tilbury, S Youssef, E Churchill, D Everett, R Asboe, D Mandalia, S Korat, H Taylor, C Gleisner, Z Ibrahim, F Campbell, L Brima, N Williams, I Youle, M Lampe, F Smith, C Tsintas, R Chaloner, C Hutchinson, S Huntington, S Mackie, N Winston, A Weber, J Ramzan, F Carder, M Lynch, J Hand, J Souza, C Munshi, S Miller, S Wood, C Wilson, A Morris, S Allan, S Palfreeman, A Memon, K ewszuk, A Chadwick, D Cope, E Gibson, J Kegg, S Main, P Mitchell, Dr Hunter, Dr Hay, P Dhillon, M Martin, F Russell‐Sharpe, S Harte, A Clay, S Tariq, A Spencer, H Jones, R Atkinson, C Delpech, V Sachikonye, M Aitken, Celia Pozniak, Anton Cane, Patricia Clark, Duncan Collins, Simon Douthwaite, Samuel White, Ellen Fraser, Christophe Geretti, Anna Maria Hale, Antony Hué, Stéphane Kaye, Steve Kellam, Paul Lazarus, Linda Leigh‐Brown, Andrew Mbisa, Tamyo Moses, Samuel Nastouli, Eleni Smit, Erasmus Templeton, Kate Tilston, Peter Webster, Daniel Zhang, Hongyi Greatorex, Jane Mullen, Jane Tandy, Richard Fawcett, Tracy Hopkins, Mark Ashton, Lynn Booth, Claire Garcia‐Diaz, Ana Shepherd, Jill Schmid, Matthias L Payne, Brendan Pere, Spiro Hubb, Jonathan Kirk, Stuart Gunson, Rory Bradley‐Stewart, Amanda HIV Med Short Communication 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. John Wiley and Sons Inc. 2015-08-25 2016-05 /pmc/articles/PMC4949527/ /pubmed/26306942 http://dx.doi.org/10.1111/hiv.12302 Text en © 2015 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association. This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| spellingShingle | Short Communication Jose, S Quinn, K Dunn, D Cox, A Sabin, C Fidler, S Ainsworth, Jonathan Allan, Sris Anderson, Jane Babiker, Abdel Chadwick, David Delpech, Valerie Fisher, Martin Gazzard, Brian Gilson, Richard Gompels, Mark Hay, Phillip Hill, Teresa Johnson, Margaret Kegg, Stephen Leen, Clifford Martin, Fabiola Nelson, Mark Orkin, Chloe Palfreeman, Adrian Phillips, Andrew Pillay, Deenan Post, Frank Pritchard, Jillian Sachikonye, Memory Schwenk, Achim Tariq, Anjum Walsh, John Thornton, Alicia Glabay, Adam Perry, N Tilbury, S Youssef, E Churchill, D Everett, R Asboe, D Mandalia, S Korat, H Taylor, C Gleisner, Z Ibrahim, F Campbell, L Brima, N Williams, I Youle, M Lampe, F Smith, C Tsintas, R Chaloner, C Hutchinson, S Huntington, S Mackie, N Winston, A Weber, J Ramzan, F Carder, M Lynch, J Hand, J Souza, C Munshi, S Miller, S Wood, C Wilson, A Morris, S Allan, S Palfreeman, A Memon, K ewszuk, A Chadwick, D Cope, E Gibson, J Kegg, S Main, P Mitchell, Dr Hunter, Dr Hay, P Dhillon, M Martin, F Russell‐Sharpe, S Harte, A Clay, S Tariq, A Spencer, H Jones, R Atkinson, C Delpech, V Sachikonye, M Aitken, Celia Pozniak, Anton Cane, Patricia Clark, Duncan Collins, Simon Douthwaite, Samuel White, Ellen Fraser, Christophe Geretti, Anna Maria Hale, Antony Hué, Stéphane Kaye, Steve Kellam, Paul Lazarus, Linda Leigh‐Brown, Andrew Mbisa, Tamyo Moses, Samuel Nastouli, Eleni Smit, Erasmus Templeton, Kate Tilston, Peter Webster, Daniel Zhang, Hongyi Greatorex, Jane Mullen, Jane Tandy, Richard Fawcett, Tracy Hopkins, Mark Ashton, Lynn Booth, Claire Garcia‐Diaz, Ana Shepherd, Jill Schmid, Matthias L Payne, Brendan Pere, Spiro Hubb, Jonathan Kirk, Stuart Gunson, Rory Bradley‐Stewart, Amanda Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation |
| title | Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation |
| title_full | Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation |
| title_fullStr | Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation |
| title_full_unstemmed | Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation |
| title_short | Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation |
| title_sort | virological failure and development of new resistance mutations according to cd4 count at combination antiretroviral therapy initiation |
| topic | Short Communication |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949527/ https://www.ncbi.nlm.nih.gov/pubmed/26306942 http://dx.doi.org/10.1111/hiv.12302 |
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