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Immune Responses to ART Vary by Regimen Among Individuals With Advanced HIV


People with advanced HIV initiating bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) were more likely to reach CD4 cell count levels of 200 cells/mcL or higher compared with those initiating other antiretroviral therapy (ART) regimens.

Initiation of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) was associated with an increased likelihood of CD4 cell count recovery to levels of at least 200 cells/mcL among individuals with advanced HIV, compared with 3 other antiretroviral therapy (ART) regimens.

This finding was published in an abstract on treatment options for advanced HIV and their associated immune responses, which was presented at the AIDS 2022 conference, held July 29 to August 2 in Montreal, Canada, and virtually.

Up to 20% of Americans with newly diagnosed HIV have advanced HIV, defined as having a CD4 count less than 200 cells/mcL. Individuals with advanced HIV are also at higher risk of HIV transmission, clinical progression, poor long-term retention in care, morbidity, and mortality.

To evaluate CD4 cell count and CD4:CD8 ratio recovery after initiating ART regimens among individuals with advanced HIV, the authors conducted a study using data from the OPERA cohort. The OPERA cohort is representative of approximately 12% of the US population living with HIV, with routine clinical data prospectively captured from electronic health records at 84 clinics across 18 states and territories.

The study included 1349 adults from the OPERA cohort with advanced HIV who were ART naïve and initiated 1 of the following ART regimens between 2018 and 2020:

  • B/F/TAF
  • boosted darunavir (bDRV)
  • dolutegravir (DTG)
  • elvitegravir/cobicistat (EVG/c)

All 4 groups consisted mostly of participants who were Black, and male participants also represented a majority of each group.

A large proportion of participants in all groups had a history of AIDS, had any comorbidity, and were part of either the Ryan White HIV/AIDS Program or the AIDS Drug Assistance Program (ADAP). Those who initiated B/F/TAF were least likely to have any of those 3 characteristics compared with those initiating bDRV, DTG, or EVG/c, but the proportions of patients with those characteristics in the B/F/TAF group were still relatively high.

The authors used a Cox proportional hazard model to assess time to CD4 cell count of at least 200 cells/mcL, and a linear mixed model to assess changes in CD4:CD8 ratio from baseline.

Initiation of B/F/TAF was associated with an increased likelihood of CD4 cell count recovery to levels of at least 200 cells/mcL, with 627 of 816 participants in this group with advanced HIV achieving recovery.

In comparison, a statistically lower likelihood of achieving a CD4 cell count of 200 cells/mcL or higher was observed with bDRV (HR, 0.76; 95% CI, 0.60-0.96), DTG (HR, 0.82; 95% CI, 0.69-0.98), and EVG/c (HR, 0.73; 95% CI, 0.57-0.93).

However, CD4:CD8 ratio normalization was rare across all 4 ART regimens. Of all 1349 individuals with HIV, only 40 (4%) achieved CD4:CD8 ratio normalization.

“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,” the abstract authors wrote.


Mounzer K, Brunet L, Fusco J, et al. Advanced HIV infection in the US: immune response to ART initiation. Presented at: AIDS 2022; July 29-August 2, 2022; Montreal, Canada. Abstract 4754.

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