VIROLOGICAL RESPONSE OF RAL-BASED REGIMEN AMONG HIV-INFECTED PREGNANT WOMEN IN BRAZIL
. Pati Pascom A. Mar 4, 2019; 259341
Topic: Other
Dr. Ana Pati Pascom
Dr. Ana Pati Pascom
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Abstract
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Background: CD4 cell count recovery is an important predictor of AIDS-related morbidity and mortality,
especially among those who start antiretroviral therapy (ART) with lower counts. In this study, we aimed to
compare CD4 count recovery in patients starting ART in Brazil with TLE (Tenofovir-Lamivudine-Efavirenz)
vs TLD (Tenofovir-Lamivudine-Dolutegravir). These were the regimens recommended as preferred 1st-line
in the most recent treatment guidelines in the country, released in December 2013 (TLE) and in January
2017 (TLD).
Methods: Data was extracted from two information systems from the Brazilian Ministry of Health,
which record every viral load (VL) and CD4 count performed within the country’s public health system,
and every ART prescription. Our inclusion criteria was age 15 or older, having started ART from Jan
2014 to Jul 2017 on either TLE or TLD and having a CD4 count recorded at baseline (-180 to +30 days)
and after a year (365±90 days) from treatment initiation. CD4 count recovery was calculated as the
difference between these values, adjusted by the time interval between ART initiation and the follow
up measurement to report a standardized 365-day change. We reported median absolute yearly CD4
changes and proportions which achieved 50, 100 and 200-cell increases, with respective p-values for
the Mann-Whitney U and χ2-tests. We also performed logistic regression models adjusting for sex, age,
baseline VL and presence of viral suppression (at 365±90 days), with a 200-cell increase as the outcome,
and report the aOR and 95%CI. All analyses are stratified by baseline CD4 count: <100 cells/mm3, 100-
199 cells/mm3, 200-349 cells/mm3, and >350 cells/mm3
.
Results: 61,297 individuals were included in the analysis, of whom 7,509 (12.3%) were on TLD.
Table 1 presents baseline characteristics for each of the treatment groups. Overall, median age was
34yo, median baseline CD4 was 351 cells/mm3, and 71.2% were male. Median increase in CD4 count
was higher with TLD than with TLE in all baseline CD4 strata (all p-values <0.001). A higher absolute
difference between TLE and TLD was observed in the >350 cells/mm3 group (36 cells/mm3) and a lower
in the 100-199 cells/mm3 group (24 cells/mm3). In the multivariable analysis patients on TLD remained
significantly more likely to present a 200-cell/mm3 increase than those on TLE in all strata.
Discussion: In this population, Dolutegravir led to a higher CD4 cell recovery after the 1st year of ART
than did Efavirenz, in all strata of CD4 analyzed, both in the unadjusted analyses and after controlling
for other factors. These findings should be taken into account when choosing initial ART, especially in
patients for whom immunologic recovery is a priority.
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