Ainsworth J

Aitken C

Allan S

Anderson J

Asboe D

Ashton L

Atkinson C

Booth C

Bradley-Stewart A

Brima N

Campbell L

Cane P

Carder M

Chadwick D

Chaloner C

Churchill D

Clark D

Clay S

Collins S

Cope E

Cox A

Cumming S

de Souza C

Delpech V

Dhillon M

Douthwaite S

Dunn D

Everett R

Fawcett T

Fearnhill E

Fidler S

Fisher M

Fraser C

Garcia-Diaz A

Gazzard B

Geretti AM

Gibson J

Gilson R

Glabay A

Gleisner Z

Gompels M

Greatorex J

Gunson R

Hale A

Hand J

Harte A

Hay P

Hill T

Hopkins M

Hubb J

Hue S

Hunter

Huntington S

Hutchinson S

Ibrahim F

Johnson M

Jones R

Jose S

Kaye S

Kegg S

Kellam P

Kirk S

Korat H

Lampe F

Lazarus L

Leen C

Leigh-Brown A

Lewszuk A

Lynch J

Mackie N

Main P

Mandalia S

Martin F

Mbisa T

Memon K

Miller S

Mitchell

Morris S

Moses S

Mullen J

Munshi S

\ua9 2016 British HIV Association. Objectives: No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy (cART) at CD4 counts &gt; 350 cells/μL. It is hypothesized that earlier initiation of cART in asymptomatic and otherwise healthy individuals may lead to poorer adherence and subsequently higher rates of resistance development. Methods: In a large cohort of HIV-positive individuals, we investigated the emergence of new resistance mutations upon virological treatment failure according to the CD4 count at the initiation of cART. Results: Of 7918 included individuals, 6514 (82.3%), 996 (12.6%) and 408 (5.2%) started cART with a CD4 count ≤ 350, 351-499 and ≥ 500 cells/μL, respectively. Virological rebound occurred while on cART in 488 (7.5%), 46 (4.6%) and 30 (7.4%) with a baseline CD4 count ≤ 350, 351-499 and ≥ 500 cells/μL, respectively. Only four (13.0%) individuals with a baseline CD4 count &gt; 350 cells/μL in receipt of a resistance test at viral load rebound were found to have developed new resistance mutations. This compared to 107 (41.2%) of those with virological failure who had initiated cART with a CD4 count &lt; 350 cells/μL. Conclusions: We found no evidence of increased rates of resistance development when cART was initiated at CD4 counts above 350 cells/μL. HIV Medicin

Quinn K

Sabin C

Nelson M

Palfreeman A

Post F

Pritchard J

Sachikonye M

Schwenk A

Tariq A

Walsh J

Phillips A

Thornton A

Perry N

Tilbury S

Youssef E

Taylor C

Williams I

Youle M

Smith C

Tsintas R

Winston A

Weber J

Ramzan F

Orkin C

Wood C

Wilson A

Russell-Sharpe S

Spencer H

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Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation

https://eprint.ncl.ac.uk/fulltext.aspx?url=234887/85E92C67-6BAA-41BD-9B20-4D06E9C3E192.pdf&pub_id=234887

Virological failure and development of new resistance mutations according to CD4 count at combination antiretroviral therapy initiation

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