Immune Activation in HIV-Infected Patients Treated with Different ARV Regimens

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.