CD4 cell count response to first-line combination ART in HIV-2+ patients compared with HIV-1+ patients: a multinational, multicohort European study. Journal of Antimicrobial Chemotherapy
Wittkop et al. on behalf of the COHERE in EuroCoord and the ACHIeV2e Study Group aimed to assess CD4 cell recovery following first-line combination ART (cART) in HIV-2+ infected individuals compared to HIV-1+ infected individuals. ART-naive HIV+ adults were included, if they started first-line combination antiretroviral therapy (without NNRTIs or fusion inhibitors) between 1997 and 2011.
Overall, the study included 185 HIV-2+ and 3’0321 HIV-1+ patients with a median age of 46 years and 37 years, respectively. Median observed pretreatment CD4 cell counts/mm3 were 203 in HIV-2+ patients and in HIV-1+ patients. Mean observed CD4 cell count changes from start of cART to 12months were 105 in HIV-2 patients and 202 in HIV-1 patients, an observed difference of 97 cells/mm3 in 1 year. In adjusted analysis, the mean CD4 cell increase was overall 25 CD4 cells/mm3/year lower in HIV-2 patients compared with HIV-1 patients.
In conclusion, differences in CD4 cell dynamics between HIV-2 and HIV-1 were consistent in all analyses, with a poorer CD4 cell increase after start of treatment in HIV-2 patients, even after adjustment for pretreatment plasma viral load. The study-results underline the need to identify other factors contributing to this lower CD4 cell response, such as more potent drugs against HIV-2, adapted to the particularities of the virus replication when compared with HIV-1, in order to improve case management.