Early Changes in T-Cell Activation Predict Antiretroviral Success in Salvage Therapy of HIV Infection

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Abstract

Objective:

Because effective antiretroviral therapy (ART) reduces immune activation, we hypothesize that early changes in immune activation are associated with subsequent virologic response to therapy.

Design:

Observational cohort study.

Setting:

Institutional HIV clinic.

Subjects:

Thirty-four adult HIV patients with virologic failure on their current antiretroviral regimen.

Intervention:

Change to salvage regimen selected by patient's physician.

Main Outcome Measures:

Measures of immune activation at baseline and at 2, 4, 8, and 24 weeks after enrollment. Data were analyzed by proportional hazards (PH) models.

Results:

PH models showed that reductions between baseline and week 2 in expression of CD38 (P = 0.02) or CD95 (P = 0.02) on CD4+ T cells were associated with increased likelihood of achieving virologic suppression. Kaplan-Meier analysis demonstrated that patients who had reductions within the first 2 weeks of therapy in CD4+ T-cell expression of CD38 (P = 0.003) or CD95 (P = 0.08) were more likely to achieve viral suppression than those who did not.

Conclusions:

Reduced CD4+ T-cell expression of CD38 and CD95 occurring within 2 weeks of salvage therapy is associated with subsequent viral suppression. Monitoring CD38 and CD95 may allow earlier assessment of the response to ART.

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