Predictors of CD4+ T-cell counts of HIV type 1-infected persons after virologic failure of all 3 original antiretroviral drug classes

Abstract

Background. Low CD4+ T-cell counts are the main factor leading to clinical progression in human immunodeficiency virus type 1 (HIV-1) infection. We aimed to investigate factors affecting CD4+ T-cell counts after triple-class virological failure.Methods. We included individuals from the COHERE database who started antiretroviral therapy from 1998 onward and who experienced triple-class virological failure. CD4+ T-cell counts obtained after triple-class virologic failure were analyzed using generalized estimating equations.Results. The analyses included 2424 individuals with a total of 23 922 CD4+ T-cell count measurements. In adjusted models (excluding current viral load and year), CD4+ T-cell counts were higher with regimens that included boosted protease inhibitors (increase, 22 cells/μL [95% confidence interval {CI}, 3.9-41]; P =. 017) or drugs from the new classes (increase, 39 cells/μL [95% CI, 15-62]; P =. 001), compared with nonnucleoside reverse-transcriptase inhibitor-based regimens. These associations disappeared when current viral load and/or calendar year were included. Compared with viral levels of <2.5 log10 copies/mL, levels of 2.5-3.5, 3.5-4.5, 4.5-5.5, and >5.5 log10 copies/mL were associated with CD4+ T-cell count decreases of 51, 84, 137, and 186 cells/μL, respectively (P