Factors associated with short-term changes in HIV viral load and CD4(+) cell count in antiretroviral-naive individuals

Natural History Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord, Fumiyo Nakagawa, Rebecca Lodwick, Colette Smith, Dominique Costagliola, Ard van Sighem, Bruno Ledergerber, Antonella d'Arminio Monforte, Maria Dorrucci, Carlo Torti, Ignacio Suarez-Lozano, Niels Obel, Norbert Brockmeyer, Rodolphe Thiebaut, Jens Lundgren, Antonella Castagna, Belén Alejos, Stéphane De Wit, Robert Zangerle, Nikos Pantazis, Kathrin Ehren, Jordi Casabona, Jesper Grarup, Geneviève Chêne, Andrew Phillips, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Jade Ghosn, Catherine Leport, Peter Reiss, Ferdinand Wit, Maria Prins, Heiner C Bucher, Caroline Sabin, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Pérez-Hoyos, Osamah Hamouda, Barbara Gussenheimer-Bartmeyer, Antoni Noguera-Julian, Andrea Antinori, Antonella d'Arminio Monforte, Norbert Brockmeyer, José Ramos, Manuel Battegay, Andri Rauch, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M Miró, Antonella Castagna, Stephane de Wit, Tessa Goetghebuer, Carlo Torti, Ramon Teira, Myriam Garrido, Ali Judd, Josiane Warszawski, David Haerry, Ian Weller, Jordi Casabona, Dominique Costagliola, Antonella d'Arminio-Monforte, Manuel Battegay, Stephane de Wit, Julia Del Amo, Jesper Grarup, Geneviève Chêne, Céline Colin, Christine Schwimmer, Monique Termote, Diana Barger, Jesper Kjaer, Maria Campbell, Dorthe Raben, Manuel Battegay, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, François Dabis, Antonella d'Arminio Monforte, Julia del Amo, Maria Dorrucci, Matthias Egger, Frederik Engsig, Hansjakob Furrer, Ali Judd, Ole Kirk, Olivier Lambotte, Charlotte Lewden, Sara Lodi, Rebecca Lodwick, Sophie Matheron, Laurence Meyer, Jose Miro, Amanda Mocroft, Susana Monge, Fumiyo Nakagawa, Niels Obel, Roger Paredes, Andrew Phillips, Massimo Puoti, Joanne Reekie, Caroline Sabin, Alexandra Scherrer, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Giota Touloumi, Linda Wittkop, Natural History Project Working Group for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) in EuroCoord, Fumiyo Nakagawa, Rebecca Lodwick, Colette Smith, Dominique Costagliola, Ard van Sighem, Bruno Ledergerber, Antonella d'Arminio Monforte, Maria Dorrucci, Carlo Torti, Ignacio Suarez-Lozano, Niels Obel, Norbert Brockmeyer, Rodolphe Thiebaut, Jens Lundgren, Antonella Castagna, Belén Alejos, Stéphane De Wit, Robert Zangerle, Nikos Pantazis, Kathrin Ehren, Jordi Casabona, Jesper Grarup, Geneviève Chêne, Andrew Phillips, Robert Zangerle, Giota Touloumi, Josiane Warszawski, Laurence Meyer, François Dabis, Murielle Mary Krause, Jade Ghosn, Catherine Leport, Peter Reiss, Ferdinand Wit, Maria Prins, Heiner C Bucher, Caroline Sabin, Diana Gibb, Gerd Fätkenheuer, Julia Del Amo, Niels Obel, Claire Thorne, Amanda Mocroft, Ole Kirk, Christoph Stephan, Santiago Pérez-Hoyos, Osamah Hamouda, Barbara Gussenheimer-Bartmeyer, Antoni Noguera-Julian, Andrea Antinori, Antonella d'Arminio Monforte, Norbert Brockmeyer, José Ramos, Manuel Battegay, Andri Rauch, Cristina Mussini, Pat Tookey, Jordi Casabona, Jose M Miró, Antonella Castagna, Stephane de Wit, Tessa Goetghebuer, Carlo Torti, Ramon Teira, Myriam Garrido, Ali Judd, Josiane Warszawski, David Haerry, Ian Weller, Jordi Casabona, Dominique Costagliola, Antonella d'Arminio-Monforte, Manuel Battegay, Stephane de Wit, Julia Del Amo, Jesper Grarup, Geneviève Chêne, Céline Colin, Christine Schwimmer, Monique Termote, Diana Barger, Jesper Kjaer, Maria Campbell, Dorthe Raben, Manuel Battegay, Julia Bohlius, Vincent Bouteloup, Heiner Bucher, Alessandro Cozzi-Lepri, François Dabis, Antonella d'Arminio Monforte, Julia del Amo, Maria Dorrucci, Matthias Egger, Frederik Engsig, Hansjakob Furrer, Ali Judd, Ole Kirk, Olivier Lambotte, Charlotte Lewden, Sara Lodi, Rebecca Lodwick, Sophie Matheron, Laurence Meyer, Jose Miro, Amanda Mocroft, Susana Monge, Fumiyo Nakagawa, Niels Obel, Roger Paredes, Andrew Phillips, Massimo Puoti, Joanne Reekie, Caroline Sabin, Alexandra Scherrer, Colette Smit, Jonathan Sterne, Rodolphe Thiebaut, Claire Thorne, Carlo Torti, Giota Touloumi, Linda Wittkop

Abstract

Objectives: Among antiretroviral therapy (ART)-naive individuals, viral load levels tend to increase and CD4(+) cell counts decline over time. We sought to explore the rate of change and influence of other factors associated with these markers of HIV progression.

Design: An observational cohort collaboration study.

Methods: A total of 158 385 pairs of consecutive viral load and CD4(+) cell count simultaneously measured from 34 384 ART-naive individuals in the COHERE database were analysed. Annual changes and factors associated with these changes were estimated using generalized estimating equations.

Results: Viral load continued to rise at a mean [95% confidence interval (CI)] rate of 0.091 (0.086-0.096) log10 copies/ml per year. A faster rise in viral load was significantly associated with older age, such that for every 10 years older, it was a mean 0.022 log10 copies/ml per year greater. The mean (95% CI) CD4(+) cell count change was -78.0 (-80.1 to -76.0) cell/μl per year and it was strongly associated with a higher current viral load: for every 1 log10 copies/ml higher, CD4(+) cell count declined by an additional 37.6 cells/μl per year (P < 0.001). Current viral load was a stronger predictor of CD4(+) cell count depletion than baseline viral load. Neither sex, race nor transmission by injecting drug use was associated with change in either the viral load or CD4(+) cell count.

Discussion: We found that in ART-naive individuals, viral load continues to increase over time and more sharply in those who are older. Our results also suggest that higher current viral load is strongly associated with ongoing rate of CD4(+) cell count depletion.

Figures

Fig. 1
Fig. 1
Estimated CD4+ cell count decline per year by viral load category at t0.

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Source: PubMed

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