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Immunological function restoration with Lopinavir/ritonavir vs Efavirenz containing regimens in HIV infected patients: a randomized clinical trial

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CD4+ count increase has been reported to be different with lopinavir/r (LPV/r) and efavirenz (EFV)-containing regimens. The different effect of these two regimens on other immune function parameters and the relationship with the gain of CD4+ count have not been assessed in a randomized clinical trial. Fifty antiretroviral treatment (cART) naïve HIV-infected individuals were randomized to receive LPV/r or EFV both with tenofovir/emtricitabine for 48 weeks. A substudy of immunological function restoration was performed in 22 patients (LPV/r n=10 and EFV n=12). Activation, thymic function, apoptosis, senescence, exhaustion, Treg cells, interleukin (IL)-7-receptor/IL-7 system, thymic volume, and lymphoid tissue fibrosis were evaluated at baseline and at week 48. Both groups experienced a CD4+ count increase that was higher in the EFV group (ΔCD4+ 88 vs. 315 cells/μl LPV/r vs. EFV, respectively, p<0.001). Despite this difference in CD4+ gain, the change in other immune function parameters was similar in both treatment groups. Most of parameters evaluated tended to normalize after 48 weeks of cART. A significant decrease in levels of activation, senescence, exhaustion, and apoptosis on CD4+ and CD8+ T cells (p<0.001 for all) and a significant increase in markers of thymic function, IL-7 receptor, and in the levels of central memory CD4+ T cells and naive subsets of CD8+ T cells (p<0.001 for all) with respect to baseline values were observed without any difference between groups. These data indicate that the differences in CD4+ gain with different cART regimens are not immunologically meaningful and might explain the similar clinical efficacy of these regimens.

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TORRES MURILLO, Berta, RALLÓN, Norma, LONCÁ, Montserrat, DÍAZ LORCA, Maria alba, ALÓS I HERNÁNDEZ, Llúcia, MARTÍNEZ CHAMORRO, Esteban josé, CRUCETA, Anna, ARNAIZ GARGALLO, Juan alberto, LEAL, Lorna, LUCERO, Constanza, LEÓN GARCÍA, Agathe, SÁNCHEZ, Marcelo, NEGREDO, Eugènia, CLOTET, Bonaventura, GATELL, José m., BENITO, José m., GARCÍA ALCAIDE, Felipe. Immunological function restoration with Lopinavir/ritonavir vs Efavirenz containing regimens in HIV infected patients: a randomized clinical trial. _Aids Research and Human Retroviruses_. 2014. Vol. 30, núm. 5, pàgs. 425-433. [consulta: 22 de gener de 2026]. ISSN: 0889-2229. [Disponible a: https://hdl.handle.net/2445/106786]

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