TY  - BOOK
AU  - Gilson, R.
AU  - Man, S.L
AU  - Copas, A
AU  - Rider, A
AU  - Forsyth, S
AU  - Hill, T
AU  - Bansi, L.
AU  - Porter, K.
AU  - Gazzard, B.
AU  - Orkin, C.
AU  - Pillay, D.
AU  - Schwenk, A
AU  - Johnson, M.
AU  - Easterbrook, P.
AU  - Walsh, J
AU  - Fisher, M.
AU  - Leen, C.
AU  - Anderson, J.
AU  - Sabin, C.A.
ED  - UK Collaborative HIV Cohort Study Group
TI  - Discordant responses on starting HAART: suboptimal CD4 increases despite early viral suppression in the UK Collaborative HIV Cohort Study (UK CHIC)
PY  - 2010///
N1  - NMUH Staff Publications; 11
N2  - <div><h4>OBJECTIVES: </h4><p>Patients starting highly active antiretroviral therapy (HAART) may have a suboptimal CD4 increase despite rapid virological suppression. The frequency and the significance for patient care of this discordant response are uncertain. This study was designed to determine the incidence of a discordant response at two time-points, soon after 6 months and at 12 months, and to determine the relationship with clinical outcomes.</p><h4>METHODS: </h4><p>Data obtained in the UK Collaborative HIV Cohort Study were analysed. A total of 2584 treatment-naïve patients starting HAART with HIV viral load (VL) > 1000 HIV-1 RNA copies/mL at baseline and < 50 copies/mL within 6 months were included in the analysis. Patients were classified at either 6-10 (midpoint 8) months or 10-14 (midpoint 12) months as having a discordant (CD4 count increase < 100 cells/microL from baseline) or concordant response (CD4 count increase >or= 100 cells/microL).</p><h4>RESULTS: </h4><p>Discordant responses occurred in 32.1% of patients at 8 months and in 24.2% at 12 months; 35% of those discordant at 8 months were concordant at 12 months. A discordant response was associated with older age, lower baseline VL, and (at 12 months) higher baseline CD4 cell count. In a multivariate analysis it was associated with an increased risk of death, more strongly at 12 months [incidence rate ratio (IRR) 3.35, 95% confidence interval (CI) 1.73-6.47, P < 0.001] than at 8 months (IRR 2.08, 95% CI 1.19-3.64, P = 0.010), but not with new AIDS events.</p><h4>CONCLUSIONS: </h4><p>Discordant responders have a worse outcome, but assessment at 12 months may be preferred, given the number of 'slow' responders. Management strategies to improve outcomes for discordant responders need to be investigated.</p></div&gt
UR  - http://onlinelibrary.wiley.com/doi/10.1111/j.1468-1293.2009.00755.x/full
ER  -