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  AIDS 2022
July 29 - Aug 2
24th Intl AIDS Conference
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Advanced HIV infection in the US: immune response to ART initiation
  AIDS 2022 July 29-Aug 2 Montreal
Karam Mounzer
K. Mounzer * (1), L. Brunet (2), J. Fusco (2), I. McNicholl (3), M. Dunbar (3), M. Sension (4), L. McCurdy (5), G. Fusco (2)
(1) University of Pennsylvania, School of Medicine, Philadelphia, United States, (2) Epividian, Durham, United States, (3) Gilead Sciences, Inc, Foster City, United States, (4) CAN Community Health, Sarasota, United States, (5) Atrium Health, Charlotte, United States


BACKGROUND: Up to 20% of individuals newly diagnosed with HIV in the US have advanced HIV infection (CD4<200 cells/AμL). We compared the absolute CD4 cell count and CD4:CD8 ratio recovery among people with advanced HIV after common antiretroviral therapy (ART) regimens initiation in 2018-2020.
METHODS: In the OPERA cohort, all ART-naïve, adults with advanced HIV (CD4<200 cells/AμL) initiating bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or a boosted darunavir (bDRV)-, dolutegravir (DTG)- or elvitegravir/cobicistat (EVG/c)-based three-drug regimen were selected. A Cox proportional hazard model was used to assess time to CD4 cell count '200 cells/AμL. A linear mixed model was used to assess changes in CD4:CD8 ratio from baseline. Inverse probability weighting was employed to control for confounding (Figure).
RESULTS: Of 1349 individuals included, those initiating B/F/TAF were least likely to have a history of AIDS-defining illness, any comorbidity or ADAP/Ryan White coverage (Table). Compared to those initiating B/F/TAF, a statistically lower likelihood of achieving a CD4 cell count '200 cells/AμL was observed (HR; 95% CI) with bDRV (0.76; 0.60-0.96), DTG (0.82; 0.69-0.98) and EVG/c (0.73; 0.57-0.93; Figure A). All groups presented a similar pattern of CD4:CD8 ratio changes: a rapid increase in the first 6 months, followed by a slower increase thereafter (Figure B). Overall, only 40 individuals (4%) achieved CD4:CD8 ratio normalization ('1).
CONCLUSIONS: Among individuals with advanced HIV infection, B/F/TAF initiation was associated with a faster CD4 cell count recovery (>200 cells/AμL). No difference was observed in CD4:CD8 ratio changes over time across groups; CD4:CD8 ratio normalization was rare with all regimens.