Volume 9 Supplement 1
Immunological effect of ten-year c-ART in treatment-naive and pre-treated HIV-1 patients in Bulgaria
- Ivaylo Elenkov†1,
- Maria Nikolova†2Email author,
- Ivanka Radeva1,
- Margarita Yankova1 and
- Nina Yancheva1
© Elenkov et al; licensee BioMed Central Ltd. 2012
Published: 25 May 2012
Highly effective combination anti-retroviral therapy (c-ART) has been applied in Bulgaria since 1999. The aim of the present study was to compare retrospectively the long-term immunological effect of c-ART in treatment-naïve and pre-treated HIV-1+ patients.
Patients and methods
The study included HIV-1+ patients (n=56) that have started c-ART between March 1999 and December 2001, have been on continuous treatment, with good adherence, death being the only reason for ART stop. Of them, 27 had a history of irregular pre-treatment with AZT or AZT/LMV for an average of 4.6 yrs (Group A), and 29 were ART-naïve (Group B). CD4 absolute counts (AC) were determined by single-platform flow cytometry (BD Biosciences). Viral load (VL) was measured by RT-PCR (Roche). Comparisons were performed by unpaired t-test (SPSS 17.0).
The demographic characteristics of groups A and B did not differ significantly: mean age (yrs): 34 vs. 35; male to female ratio: 9 vs. 7, respectively. Baseline CD4 AC (cells/ml) and VL (log HIV RNA copies/ml) were comparable: mean 124 vs. 119, and 5.1 vs. 4.6, respectively, (p>0.05 for both comparisons). In the long term, suppression of viral replication was observed in both groups: mean VL at 5 yrs 3.7 vs. 3.1 for groups A and B, respectively, (p>0.05). However, treatment-naïve patients (group B) had a better immune recovery than group A, and the difference became significant in the long term: mean CD4 AC 177 vs. 252 after 6 months of c-ART, (p>0.05), 391 vs. 240 at 2 yrs (p
Similarly to other studies, (SHM Monitoring report, 2009), a more complete and lasting long-term immunologic response to c-ART was observed in treatment – naïve patients. According to us, a previous sub-optimal and irregularly applied ART regimen, may promote the selection of gradually outgrowing drug-resistant viral strains, compromising therapeutic efficacy in the long run.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.