TY - JOUR
T1 - Integrase Inhibitors Use and Cytomegalovirus Infection Predict Immune Recovery in People Living With HIV Starting First-Line Therapy
AU - Fabbiani, Massimiliano
AU - Borghetti, Alberto
AU - Squillace, Nicola
AU - Colafigli, Manuela
AU - Taramasso, Lucia
AU - Lombardi, Andrea
AU - Rossetti, Barbara
AU - Ciccullo, Arturo
AU - Colella, Elisa
AU - Picarelli, Chiara
AU - Berruti, Marco
AU - Latini, Alessandra
AU - Montagnani, Francesca
AU - Sambo, Margherita
AU - Di Biagio, Antonio
AU - Di Biagio, Anna
AU - Gori, Andrea
AU - Di Giambenedetto, Simona
AU - Bandera, Alessandra
PY - 2021
Y1 - 2021
N2 - BACKGROUND: We explored predictors of CD4/CD8 ratio improvement and optimal immunological recovery (OIR) after initiation of antiretroviral therapy (ART) in naive people living with HIV (PLWH). METHODS: Retrospective multicenter study including naive PLWH starting ART with 2 nucleos(t)ide reverse transcriptase inhibitors + 1 integrase strand transfer inhibitor (InSTI) or non-NRTI or protease inhibitor (PI). PLWH were followed from the time of ART initiation (baseline) to the discontinuation of first-line regimen, virological failure, death, or loss to follow-up. Estimated incidence and predictors of time to CD4/CD8 ratio normalization (defined as ≥1) and OIR (defined as CD4/CD8 ratio ≥ 1 plus CD4 ≥ 500 cells/µL plus CD4% ≥ 30%) were explored by Kaplan-Meier curves and Cox regression analysis. RESULTS: Overall, 1428 PLWH (77.8% males, median age 39 years, 55.1% with positive cytomegalovirus (CMV) antibodies, median HIV-RNA 4.80 log copies/mL, median CD4 323 cells/µL, median CD4/CD8 ratio 0.32) were included, of which 21.5% (n = 307), 44.5% (n = 636), and 34% (n = 485) treated with InSTI-, PI-, and NNRTI-based regimens, respectively. The estimated proportion of CD4/CD8 normalization and OIR at 36 months was 38.6% and 32.9%, respectively. Multivariate analysis showed that InSTI-based regimens had a higher probability of CD4/CD8 ratio normalization and OIR both in the total population (P < 0.001 versus PI) and in advanced naive PLWH (P ≤ 0.001 versus PI and NNRTI). Moreover, subjects with positive CMV serology showed a lower probability of CD4/CD8 ratio normalization and OIR (P < 0.001). CONCLUSIONS: InSTI-based regimens showed a better immune recovery, suggesting that the type of first-line ART can influence immune reconstitution. PLWH with positive CMV serology showed an increased risk of suboptimal immune recovery.
AB - BACKGROUND: We explored predictors of CD4/CD8 ratio improvement and optimal immunological recovery (OIR) after initiation of antiretroviral therapy (ART) in naive people living with HIV (PLWH). METHODS: Retrospective multicenter study including naive PLWH starting ART with 2 nucleos(t)ide reverse transcriptase inhibitors + 1 integrase strand transfer inhibitor (InSTI) or non-NRTI or protease inhibitor (PI). PLWH were followed from the time of ART initiation (baseline) to the discontinuation of first-line regimen, virological failure, death, or loss to follow-up. Estimated incidence and predictors of time to CD4/CD8 ratio normalization (defined as ≥1) and OIR (defined as CD4/CD8 ratio ≥ 1 plus CD4 ≥ 500 cells/µL plus CD4% ≥ 30%) were explored by Kaplan-Meier curves and Cox regression analysis. RESULTS: Overall, 1428 PLWH (77.8% males, median age 39 years, 55.1% with positive cytomegalovirus (CMV) antibodies, median HIV-RNA 4.80 log copies/mL, median CD4 323 cells/µL, median CD4/CD8 ratio 0.32) were included, of which 21.5% (n = 307), 44.5% (n = 636), and 34% (n = 485) treated with InSTI-, PI-, and NNRTI-based regimens, respectively. The estimated proportion of CD4/CD8 normalization and OIR at 36 months was 38.6% and 32.9%, respectively. Multivariate analysis showed that InSTI-based regimens had a higher probability of CD4/CD8 ratio normalization and OIR both in the total population (P < 0.001 versus PI) and in advanced naive PLWH (P ≤ 0.001 versus PI and NNRTI). Moreover, subjects with positive CMV serology showed a lower probability of CD4/CD8 ratio normalization and OIR (P < 0.001). CONCLUSIONS: InSTI-based regimens showed a better immune recovery, suggesting that the type of first-line ART can influence immune reconstitution. PLWH with positive CMV serology showed an increased risk of suboptimal immune recovery.
KW - Adult
KW - Anti-HIV Agents
KW - CD4-CD8 Ratio
KW - CMV
KW - Cytomegalovirus Infections
KW - Female
KW - HIV Infections
KW - HIV Protease Inhibitors
KW - HIV-1
KW - Humans
KW - Integrase Inhibitors
KW - Male
KW - Retrospective Studies
KW - Reverse Transcriptase Inhibitors
KW - immune reconstitution
KW - integrase strand transfer inhibitors
KW - nonnucleoside reverse transcriptase inhibitors
KW - protease inhibitors
KW - Adult
KW - Anti-HIV Agents
KW - CD4-CD8 Ratio
KW - CMV
KW - Cytomegalovirus Infections
KW - Female
KW - HIV Infections
KW - HIV Protease Inhibitors
KW - HIV-1
KW - Humans
KW - Integrase Inhibitors
KW - Male
KW - Retrospective Studies
KW - Reverse Transcriptase Inhibitors
KW - immune reconstitution
KW - integrase strand transfer inhibitors
KW - nonnucleoside reverse transcriptase inhibitors
KW - protease inhibitors
UR - http://hdl.handle.net/10807/193223
U2 - 10.1097/QAI.0000000000002525
DO - 10.1097/QAI.0000000000002525
M3 - Article
SN - 1525-4135
VL - 86
SP - 119
EP - 127
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
ER -