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Natural evolution of CD4+ cell count in patients with CD4 >350 or >500 cells/mm3 at the time of diagnosis according to HIV‐1 coreceptor tropism

The HIV‐1 coreceptor usage may play a critical role in AIDS pathogenesis and the X4‐using viruses are considered to be more pathogenic than the R5‐tropic viruses. These observations may influence the therapeutic decisions by asking for an earlier antiretroviral (ARV) treatment for the patients infected by the X4‐tropic viruses compared with those infected by the R5‐tropic viruses. The natural evolution of CD4+ cell count for 109 non‐treated patients infected by the R5‐ or X4‐tropic HIV‐1 viruses with CD4+ >350 and >500 cells/mm3 at time of diagnosis was compared until the initiation of an ARV regimen. The coreceptor usage was determined from the V3 env region sequence by Geno2Pheno (false positive rate 10%). A mixed linear regression model to analyse the CD4+ data with tropism as fixed effect in the model was used. Overall, 93 (85.3%) and 16 (14.7%) were infected by R5‐ and X4‐tropic viruses, respectively. The median age, baseline CD4+ cell count, and viral load were 34 years (IQR: 30–42), 523 cells/mm3 (IQR: 420–604), and 4.5 log10 copies/ml (IQR: 3.9–5.0), respectively. There was no statistical difference in time to progression between the patients harboring R5‐ or X4‐tropic viruses. The same results were observed for the sub‐group of patients with CD4+ cell count >500 cells/mm3. The virus tropism has no impact on the CD4+ cell count evolution in these HIV‐1 patients diagnosed with CD4+ >350 or >500 cells/mm3 suggesting that the tropism determination at time of diagnosis does not seem to be a useful tool to predict the clinical progression. J. Med. Virol. 84:1853–1856, 2012. © 2012 Wiley Periodicals, Inc.