Abstract
To assess whether African ethnicity is independently associated with a poorer CD4 reconstitution with highly active antiretroviral therapy (HAART) compared to Caucasian ethnicity. We conducted a retrospective epidemiological study among 575 HIV-1-positive patients at our center and defined immunological success as the presence of blood CD4 lymphocyte counts>500 cells/mm3 in more than 50% of the values collected from 6 to 48 months after beginning HAART. Patients displaying an HIV-1 viral load>200 copies/ml or more than one HIV-1 viral load between 20 and 200 copies/ml during follow-up, were excluded. Patients with baseline blood CD4 counts>500 cells/mm3 were also excluded. Two hundred and eighty patients met the inclusion criteria and no exclusion criteria. After 48 months of HAART, blood CD4 lymphocyte counts were lower in Africans than in Caucasians: 449 (65-975) vs. 569 (131-1698) cells/mm3 (p=0.02). Immunological success was present in 142/220 (64.5%) Caucasians vs. 29/60 (48.3%) Africans (p=0.02). African ethnicity was independently associated with the absence of immunological success (odds ratio 2.22, 95% confidence interval 1.097-4.504; p=0.02) despite similar baseline blood CD4 counts (219 vs. 204 cells/mm3, p=0.72). Our findings suggest that African ethnicity is independently associated with a poorer CD4 reconstitution during HAART than Caucasian ethnicity.
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