Imperial College London
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Professor Sarah Fidler BSc. MBBS. FRCP. PhD

Faculty of Medicine, Department of Infectious Disease

Professor of HIV and Communicable Diseases
 
 
 
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Contact

 

+44 (0)20 7594 6230s.fidler

 
 
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Location

 

clinical trial centre Winston Churchill wingMedical SchoolSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Fatti:2020:cid/ciz214,
author = {Fatti, G and Grimwood, A and Nachega, JB and Nelson, JA and LaSorda, K and Zyl, GV and Grobbelaar, N and Ayles, H and Hayes, R and Beyers, N and Fidler, S and Bock, P and HPTN, 071 PopART study team},
doi = {cid/ciz214},
journal = {Clinical Infectious Diseases},
pages = {395--403},
title = {Better virological outcomes amongst people living with HIV initiating early antiretroviral treatment (CD4 counts ≥ 500 cells/µL) in the HPTN 071 (PopART) trial in South Africa},
url = {http://dx.doi.org/10.1093/cid/ciz214},
volume = {70},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: There have been concerns about reduced adherence and HIV virological suppression (VS) amongst clinically well people living with HIV initiating antiretroviral treatment (ART) with high pre-ART CD4 cell counts. We compared virological outcomes by pre-ART CD4 count, where universal ART initiation was provided in the HPTN 071 (PopART) trial in South Africa prior to routine national and international implementation. METHODS: This prospective cohort study included adults initiating ART at facilities providing ART irrespective of CD4 count since January 2014. VS (<400 copies/ml), confirmed virological failure (VF) (two consecutive viral loads>1000 copies/ml) and viral rebound were compared between participants in strata of baseline CD4 count. RESULTS: The sample included 1901 participants. VS was 94% or greater amongst participants with baseline CD4 count ≥500 cells/µL at all six-monthly intervals to 30 months of ART. The risk of an elevated viral load (≥400 copies/ml) was independently lower amongst participants with baseline CD4 count ≥500 cells/µL (3.3%) compared to those with CD4 count 200-499 cell/µL (9.2%) between months 18-30, adjusted relative risk=0.30 (95% CI: 0.12-0.74, P=0.010). The incidence rate of VF was 7.0, 2.0 and 0.5 per 100 person-years amongst participants with baseline CD4 count <200, 200-499 and ≥500 cells/µL, respectively (P<0.0001). VF was independently lower amongst participants with baseline CD4 count ≥500 cells/µL, adjusted hazard ratio (aHR)=0.23, P=0.045; and three-fold higher amongst those with baseline CD4 count <200 cells/µL, aHR=3.49, P<0.0001. CONCLUSION: Despite previous concerns, participants initiating ART with CD4 counts ≥500 cells/µL had very good virological outcomes, being better than those with CD4 counts 200-499 cells/µL.
AU  - Fatti,G
AU  - Grimwood,A
AU  - Nachega,JB
AU  - Nelson,JA
AU  - LaSorda,K
AU  - Zyl,GV
AU  - Grobbelaar,N
AU  - Ayles,H
AU  - Hayes,R
AU  - Beyers,N
AU  - Fidler,S
AU  - Bock,P
AU  - HPTN,071 PopART study team
DO  - cid/ciz214
EP  - 403
PY  - 2020///
SN  - 1058-4838
SP  - 395
TI  - Better virological outcomes amongst people living with HIV initiating early antiretroviral treatment (CD4 counts ≥ 500 cells/µL) in the HPTN 071 (PopART) trial in South Africa
T2  - Clinical Infectious Diseases
UR  - http://dx.doi.org/10.1093/cid/ciz214
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30877753
UR  - http://hdl.handle.net/10044/1/69352
VL  - 70
ER  -
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