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A comparison of the immunologic efficacy of antiretroviral therapy in North America versus Africa

Cape Town, South Africa


The immunologic response to highly active antiretroviral therapy (HAART), as assessed by the change in CD4+ T cell count, is a critical determinant in the overall clinical response to therapy. The immunologic “efficacy” – or “best expected response” of HAART – can be best estimated by limiting analysis to persons achieving and maintaining virologic suppression, thus eliminating the influence of virologic failure on CD4+ T cell count change. While the immunologic efficacy of HAART has been assessed in resource-rich settings, such as North America, much less known about other regions, particularly resource-limited settings where the epidemic is concentrated. Because of differences in the host, environment, highly prevalent Tuberculosis and other endemic diseases, we hypothesize that HAART-treated patients who maintain virologic suppression in resource-limited settings, specifically Africa, will have different CD4+ T cell responses than North Americans, even after controlling for baseline clinical and demographic factors such as age, gender, nadir CD4+ T cell count, and plasma HIV RNA level.


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