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. 2016 Jul 20;11(7):e0159446.
doi: 10.1371/journal.pone.0159446. eCollection 2016.

Discordant Treatment Responses to Combination Antiretroviral Therapy in Rwanda: A Prospective Cohort Study

Felix R Kayigamba  1 , Molly F Franke  2   3 , Mirjam I Bakker  4 , Carly A Rodriguez  2 , Emmanuel Bagiruwigize  1 , Ferdinand Wnm Wit  5   6 , Michael L Rich  3   7 , Maarten F Schim van der Loeff  5   6   8
Affiliations

Discordant Treatment Responses to Combination Antiretroviral Therapy in Rwanda: A Prospective Cohort Study

Felix R Kayigamba et al. PLoS One. .

Abstract

Introduction: Some antiretroviral therapy naïve patients starting combination antiretroviral therapy (cART) experience a limited CD4 count rise despite virological suppression, or vice versa. We assessed the prevalence and determinants of discordant treatment responses in a Rwandan cohort.

Methods: A discordant immunological cART response was defined as an increase of <100 CD4 cells/mm3 at 12 months compared to baseline despite virological suppression (viral load [VL] <40 copies/mL). A discordant virological cART response was defined as detectable VL at 12 months with an increase in CD4 count ≥100 cells/mm3. The prevalence of, and independent predictors for these two types of discordant responses were analysed in two cohorts nested in a 12-month prospective study of cART-naïve HIV patients treated at nine rural health facilities in two regions in Rwanda.

Results: Among 382 patients with an undetectable VL at 12 months, 112 (29%) had a CD4 rise of <100 cells/mm3. Age ≥35 years and longer travel to the clinic were independent determinants of an immunological discordant response, but sex, baseline CD4 count, body mass index and WHO HIV clinical stage were not. Among 326 patients with a CD4 rise of ≥100 cells/mm3, 56 (17%) had a detectable viral load at 12 months. Male sex was associated with a virological discordant treatment response (P = 0.05), but age, baseline CD4 count, BMI, WHO HIV clinical stage, and travel time to the clinic were not.

Conclusions: Discordant treatment responses were common in cART-naïve HIV patients in Rwanda. Small CD4 increases could be misinterpreted as a (virological) treatment failure and lead to unnecessary treatment changes.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart showing how Nested Cohort 1 and Nested Cohort 2 were selected from the full cohort, Rwanda, 2008–2009.
See this image and copyright information in PMC

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References

    1. Zoufaly A, van der Heiden M, Kollan C, Bogner JR, Fätkenheuer G, Wasmuth JC et al. Clinical outcome of HIV-infected patients with discordant virological and immunological response to antiretroviral therapy. J Infect Dis 2011; 203: 364–71. 10.1093/jinfdis/jiq055 - DOI - PMC - PubMed
    1. Coffey S, Volberding PA. Chapter 11: Overview of antiretroviral therapy In: Volberding PA, Greene WC, Lange JMA, Gallant JE, Sewankambo N (eds). Sande’s HIV/AIDS Medicine. 2nd Ed. St Louis: Elsevier, 2012.
    1. Mutevedzi PC, Lessells RJ, Rodger AJ, Newell ML. Association of age with mortality and virological and immunological response to antiretroviral therapy in rural South African adults. PLoS One 2011; 6: 21795. - PMC - PubMed
    1. Mocroft A, Phillips AN, Gatell J, Ledergerber B, Fisher M, Clumeck N, et al. Normalization of CD4 counts in patients with HIV-1 infection and maximum virological suppression who are taking combination antiretroviral therapy: an observational cohort study. Lancet 2007; 370: 407–13. - PubMed
    1. Bartlett JA, Fath MJ, Demasi R, Hermes A, Quinn J, Mondou E, et al. An updated systematic overview of triple combination therapy in antiretroviral-naïve HIV-infected adults. AIDS 2006; 20: 2051–64. - PubMed

Substances

Grants and funding

The Doris Duke Charitable Foundation provided financial support of this research. Technical support was provided by the Infectious Disease Network for Treatment and Research in Africa (INTERACT), funded by the Netherlands Organization for Scientific Research/Netherlands Foundation for the Advancement of Tropical Research (NWO/WOTRO) and the European Union (SANTE/2006/105-316). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.