Abstract
Objectives: To evaluate the effects of starting therapy with either Truvada (TVD) or Combivir (CBV) in combination with Efavirenz (EFV) or a boosted Protease Inhibitor (LPV/r, ATV/r, fAPV/r and SQV/r) on clinical, immunological, and virological parameters in HIV-infected antiretroviral (ARV) naive patients. Methods: Twenty-seven patients were prospectively enrolled and received TVD-EFV, 32 TVD-PI/r, 24 CBV-EFV, and 23 CBV-PI/r. Immunovirological analyses were performed at baseline and after 3, 6, 9 and 12 months after initiation of therapy; a full set of data is available for 51 patients. Results: Median CD4+ cell counts and HIV-RNA plasma viremia were comparable in the four groups of patients (TVD-EFV, TVD-PI/r, CBV-EFV, CBV-PI/r) at baseline. At month 12 HIV RNA plasma viremia was <50 cps/ml in all patients. Median CD4 cell counts increases were higher, although not significantly, in CBV-EFV and TVD-EFV patients. Finally, CD8+/CD38+/CDRO+T lymphocytes were significantly decreased after 12 months of therapy in all patients with, possibly, a faster effect seen in the EFV groups. Conclusions: Immunologic parameters are similarly affected by different ARV combinations, even if EFV-associated immunomodulation might be marginally better.
Highlights
T cell activation is an important parameter for predicting disease progression in HIV-positive, untreated patients independently of HIV viral load and CD4+ T cell counts [1,2]
Increases in these cells are known to be a strong predictor of progression to AIDS independently of CD4 counts [1,8,9] and to predict the likelihood to achieve an optimal suppression of viremia in naïve patients starting therapy [10]
We investigated the expression of activation markers in a group of naïve HIV-positive patients starting different ARV combinations containing either emtricitabine plus tenofovir fixed-dose combination (Truvada®, TVD) vs. lamivudine plus zidovudine FDC (Combivir®, CBV), given with efavirenz (EFV) or a ritonavirboosted protease inhibitor (PI/r)
Summary
T cell activation is an important parameter for predicting disease progression in HIV-positive, untreated patients independently of HIV viral load and CD4+ T cell counts [1,2]. The impairment of a number of immune parameters, involving multiple cell types, characterizes immune activation in HIV patients. The most important, and the best characterized index of immune activation seen in HIV infection is the increase of CD8+/CD38+/CD45RO+ T lymphocytes. Increases in these cells are known to be a strong predictor of progression to AIDS independently of CD4 counts [1,8,9] and to predict the likelihood to achieve an optimal suppression of viremia in naïve patients starting therapy [10]. We investigated the expression of activation markers in a group of naïve HIV-positive patients start-
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