TY - JOUR
T1 - Elevated CD8 counts during HAART are associated with HIV virologic treatment failure
AU - Krantz, Elizabeth M.
AU - Hullsiek, Katherine Huppler
AU - Okulicz, Jason F.
AU - Weintrob, Amy C.
AU - Agan, Brian K.
AU - Crum-Cianflone, Nancy F.
AU - Ganesan, Anuradha
AU - Ferguson, Tomas M.
AU - Hale, Braden R.
PY - 2011/8/15
Y1 - 2011/8/15
N2 - Objective: To evaluate whether elevated CD8 counts are associated with increased risk of virologic treatment failure in HIV-infected individuals. DESIGN:: Retrospective cohort study. Methods: US Military HIV Natural History Study participants who initiated highly active antiretroviral therapy (HAART) in 1996-2008 had 6-and 12-month post-HAART HIV RNA <400 copies per milliliter, 2 subsequent HIV viral loads and a baseline CD8 count were eligible (n = 817). Baseline was 12 months after the start of HAART, virologic failure (VF) was defined as confirmed HIV RNA 400 copies per milliliter, and CD8 counts 1200 cells per cubic millimeter were considered elevated. Cox models were used to examine the effect of baseline and time-updated CD8 counts on VF. RESULTS:: There were 216 failures for a rate of 5.6 per 100 person-years [95% confidence interval (CI): 4.9 to 6.4]. Among those initiating HAART in 2000-2008, the participants with elevated baseline CD8 counts had significantly greater risk of VF compared with those with baseline CD8 counts ≤600 cells per cubic millimeter [hazard ratio (HR) = 2.68, 95% CI: 1.13 to 6.35]. The participants with elevated CD8 counts at >20% of previous 6-month follow-up visits had a greater risk of failure at the current visit than those who did not (HR = 1.53, 95% CI: 1.14 to 2.06). Those with CD8 counts that increased after the start of HAART had a greater risk of failure than those with CD8 counts that decreased or remained the same (HR = 1.59, 95% CI: 1.19 to 2.13). Conclusions: Initial or serial elevated CD8 counts while on HAART or an increase in CD8 counts from HAART initiation may be early warnings for future treatment failure.
AB - Objective: To evaluate whether elevated CD8 counts are associated with increased risk of virologic treatment failure in HIV-infected individuals. DESIGN:: Retrospective cohort study. Methods: US Military HIV Natural History Study participants who initiated highly active antiretroviral therapy (HAART) in 1996-2008 had 6-and 12-month post-HAART HIV RNA <400 copies per milliliter, 2 subsequent HIV viral loads and a baseline CD8 count were eligible (n = 817). Baseline was 12 months after the start of HAART, virologic failure (VF) was defined as confirmed HIV RNA 400 copies per milliliter, and CD8 counts 1200 cells per cubic millimeter were considered elevated. Cox models were used to examine the effect of baseline and time-updated CD8 counts on VF. RESULTS:: There were 216 failures for a rate of 5.6 per 100 person-years [95% confidence interval (CI): 4.9 to 6.4]. Among those initiating HAART in 2000-2008, the participants with elevated baseline CD8 counts had significantly greater risk of VF compared with those with baseline CD8 counts ≤600 cells per cubic millimeter [hazard ratio (HR) = 2.68, 95% CI: 1.13 to 6.35]. The participants with elevated CD8 counts at >20% of previous 6-month follow-up visits had a greater risk of failure at the current visit than those who did not (HR = 1.53, 95% CI: 1.14 to 2.06). Those with CD8 counts that increased after the start of HAART had a greater risk of failure than those with CD8 counts that decreased or remained the same (HR = 1.59, 95% CI: 1.19 to 2.13). Conclusions: Initial or serial elevated CD8 counts while on HAART or an increase in CD8 counts from HAART initiation may be early warnings for future treatment failure.
KW - CD8 count
KW - HIV viral load suppression
KW - HIV virologic failure
KW - antiretroviral therapy
KW - human immunodeficiency virus
UR - http://www.scopus.com/inward/record.url?scp=80051548189&partnerID=8YFLogxK
U2 - 10.1097/QAI.0b013e318221c62a
DO - 10.1097/QAI.0b013e318221c62a
M3 - Article
C2 - 21602694
AN - SCOPUS:80051548189
SN - 1525-4135
VL - 57
SP - 396
EP - 403
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 5
ER -