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Characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with HIV with a pre-treatment CD4 T cell count <200 ​cells/mm(3) in Thailand()

BACKGROUND: Complete recovery of the CD4 T cell count is uncommon among chronically HIV-infected individuals with very low pre-treatment CD4 count. We studied the prevalence of chronically immune recovery and its associated factors including immune characteristics chronic HIV-infected Thais. METHODS...

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Autores principales: Han, Win Min, Ubolyam, Sasiwimol, Apornpong, Tanakorn, Kerr, Stephen J., Hansasuta, Pokrath, Gatechompol, Sivaporn, Maekanantawat, Wirach, Ruxrungtham, Kiat, Phanuphak, Praphan, Ananworanich, Jintanat, Avihingsanon, Anchalee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646671/
https://www.ncbi.nlm.nih.gov/pubmed/33251023
http://dx.doi.org/10.1016/j.jve.2020.100005
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author Han, Win Min
Ubolyam, Sasiwimol
Apornpong, Tanakorn
Kerr, Stephen J.
Hansasuta, Pokrath
Gatechompol, Sivaporn
Maekanantawat, Wirach
Ruxrungtham, Kiat
Phanuphak, Praphan
Ananworanich, Jintanat
Avihingsanon, Anchalee
author_facet Han, Win Min
Ubolyam, Sasiwimol
Apornpong, Tanakorn
Kerr, Stephen J.
Hansasuta, Pokrath
Gatechompol, Sivaporn
Maekanantawat, Wirach
Ruxrungtham, Kiat
Phanuphak, Praphan
Ananworanich, Jintanat
Avihingsanon, Anchalee
author_sort Han, Win Min
collection PubMed
description BACKGROUND: Complete recovery of the CD4 T cell count is uncommon among chronically HIV-infected individuals with very low pre-treatment CD4 count. We studied the prevalence of chronically immune recovery and its associated factors including immune characteristics chronic HIV-infected Thais. METHODS: Treatment-naïve participants (n ​= ​375) from the HIV-NAT 006 cohort with a pre-treatment CD4 T cell count after initiating antiretroviral therapy (ART) and having achieved a suppressed viremia (HIV-RNA level ​< ​400 copies/mL) were retrospectively followed at the Thai Red Cross AIDS Research Centre, Bangkok, Thailand. Suboptimal immune recovery (SIR) was defined as having a CD4(+) T cell count <200 ​cells/mm(3) for 3 years after ART initiation. A case-control sub-study matched for age, sex and pre-ART CD4 T cell count was conducted to compare immunological characteristics between SIR (n ​= ​17) and non-SIR (n ​= ​24) participants. Immunological biomarkers such as interleukin-7 (IL-7) and soluble CD14 (sCD14) and other covariates including cytomegalovirus (CMV) DNA level, baseline hemoglobin level, hepatitis B and C co-infections, and T cell subsets associated with immune activation and exhaustion were evaluated. RESULTS: Among 375 participants with pre-ART CD4 T cell counts < 200 ​cells/mm(3), the prevalence of SIR was 39.7%, 19.7% and 7.7% at years 1, 2 and 3 after starting ART, respectively. In a multivariate analysis, a pre-ART CD4 T cell count ≤100 ​cells/mm(3) (adjusted odds ratio [aOR] 9.45, 95% CI 2.92–30.61, p ​< ​0.001), older age (aOR 1.07, 95% CI 1.01–1.13, p ​= ​0.029) and baseline HIV-RNA level (aOR 0.36, 95% CI 0.21–0.59, p ​< ​0.001) were independently associated with SIR at year 3 after ART initiation. In the matched case-control sub-study (cases ​= ​17, controls ​= ​24), there was a higher prevalence of hepatitis C co-infection (18.8% vs. 0%, p ​= ​0.05), lower sCD14 levels (mean, 6.23 vs. 6.27 log(10) ​pg/mL, p ​= ​0.04), lower CD8 T cell counts (mean, 514 vs. 876, p ​= ​0.0003), lower CD4/CD8 T cell ratio (mean, 0.27 vs. 0.41, p ​= ​0.01) and higher expression of PD1 on CD8(+) T cells (74.2% vs. 65.1%, p ​= ​0.02) observed in SIR participants compared to their non-SIR counterparts at year 3 after ART initiation. CONCLUSIONS: Nearly 10% of the study participants who had achieved virological suppression failed to recover a CD4 T cell count > 200 cells/mm(3) after 3 years of ART which was with a very low pre-ART CD4 T cell count and older age. The long-term clinical outcomes of SIR participants need to be further explored.
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spelling pubmed-76466712020-11-27 Characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with HIV with a pre-treatment CD4 T cell count <200 ​cells/mm(3) in Thailand() Han, Win Min Ubolyam, Sasiwimol Apornpong, Tanakorn Kerr, Stephen J. Hansasuta, Pokrath Gatechompol, Sivaporn Maekanantawat, Wirach Ruxrungtham, Kiat Phanuphak, Praphan Ananworanich, Jintanat Avihingsanon, Anchalee J Virus Erad Original research BACKGROUND: Complete recovery of the CD4 T cell count is uncommon among chronically HIV-infected individuals with very low pre-treatment CD4 count. We studied the prevalence of chronically immune recovery and its associated factors including immune characteristics chronic HIV-infected Thais. METHODS: Treatment-naïve participants (n ​= ​375) from the HIV-NAT 006 cohort with a pre-treatment CD4 T cell count after initiating antiretroviral therapy (ART) and having achieved a suppressed viremia (HIV-RNA level ​< ​400 copies/mL) were retrospectively followed at the Thai Red Cross AIDS Research Centre, Bangkok, Thailand. Suboptimal immune recovery (SIR) was defined as having a CD4(+) T cell count <200 ​cells/mm(3) for 3 years after ART initiation. A case-control sub-study matched for age, sex and pre-ART CD4 T cell count was conducted to compare immunological characteristics between SIR (n ​= ​17) and non-SIR (n ​= ​24) participants. Immunological biomarkers such as interleukin-7 (IL-7) and soluble CD14 (sCD14) and other covariates including cytomegalovirus (CMV) DNA level, baseline hemoglobin level, hepatitis B and C co-infections, and T cell subsets associated with immune activation and exhaustion were evaluated. RESULTS: Among 375 participants with pre-ART CD4 T cell counts < 200 ​cells/mm(3), the prevalence of SIR was 39.7%, 19.7% and 7.7% at years 1, 2 and 3 after starting ART, respectively. In a multivariate analysis, a pre-ART CD4 T cell count ≤100 ​cells/mm(3) (adjusted odds ratio [aOR] 9.45, 95% CI 2.92–30.61, p ​< ​0.001), older age (aOR 1.07, 95% CI 1.01–1.13, p ​= ​0.029) and baseline HIV-RNA level (aOR 0.36, 95% CI 0.21–0.59, p ​< ​0.001) were independently associated with SIR at year 3 after ART initiation. In the matched case-control sub-study (cases ​= ​17, controls ​= ​24), there was a higher prevalence of hepatitis C co-infection (18.8% vs. 0%, p ​= ​0.05), lower sCD14 levels (mean, 6.23 vs. 6.27 log(10) ​pg/mL, p ​= ​0.04), lower CD8 T cell counts (mean, 514 vs. 876, p ​= ​0.0003), lower CD4/CD8 T cell ratio (mean, 0.27 vs. 0.41, p ​= ​0.01) and higher expression of PD1 on CD8(+) T cells (74.2% vs. 65.1%, p ​= ​0.02) observed in SIR participants compared to their non-SIR counterparts at year 3 after ART initiation. CONCLUSIONS: Nearly 10% of the study participants who had achieved virological suppression failed to recover a CD4 T cell count > 200 cells/mm(3) after 3 years of ART which was with a very low pre-ART CD4 T cell count and older age. The long-term clinical outcomes of SIR participants need to be further explored. Elsevier 2020-07-19 /pmc/articles/PMC7646671/ /pubmed/33251023 http://dx.doi.org/10.1016/j.jve.2020.100005 Text en © 2020 Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original research
Han, Win Min
Ubolyam, Sasiwimol
Apornpong, Tanakorn
Kerr, Stephen J.
Hansasuta, Pokrath
Gatechompol, Sivaporn
Maekanantawat, Wirach
Ruxrungtham, Kiat
Phanuphak, Praphan
Ananworanich, Jintanat
Avihingsanon, Anchalee
Characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with HIV with a pre-treatment CD4 T cell count <200 ​cells/mm(3) in Thailand()
title Characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with HIV with a pre-treatment CD4 T cell count <200 ​cells/mm(3) in Thailand()
title_full Characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with HIV with a pre-treatment CD4 T cell count <200 ​cells/mm(3) in Thailand()
title_fullStr Characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with HIV with a pre-treatment CD4 T cell count <200 ​cells/mm(3) in Thailand()
title_full_unstemmed Characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with HIV with a pre-treatment CD4 T cell count <200 ​cells/mm(3) in Thailand()
title_short Characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with HIV with a pre-treatment CD4 T cell count <200 ​cells/mm(3) in Thailand()
title_sort characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with hiv with a pre-treatment cd4 t cell count <200 ​cells/mm(3) in thailand()
topic Original research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646671/
https://www.ncbi.nlm.nih.gov/pubmed/33251023
http://dx.doi.org/10.1016/j.jve.2020.100005
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