{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:30:54Z","timestamp":1761863454738},"reference-count":16,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,8,25]],"date-time":"2015-08-25T00:00:00Z","timestamp":1440460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["G0000199","G0600337","G0900274","M004236"],"award-info":[{"award-number":["G0000199","G0600337","G0900274","M004236"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["HIV Medicine"],"published-print":{"date-parts":[[2016,5]]},"abstract":"Objectives<\/jats:title>No randomized controlled trials have yet reported an individual patient benefit of initiating combination antiretroviral therapy (cART<\/jats:styled-content>) at CD<\/jats:styled-content>4 counts >\u00a0350 cells\/\u03bcL. It is hypothesized that earlier initiation of cART<\/jats:styled-content> in asymptomatic and otherwise healthy individuals may lead to poorer adherence and subsequently higher rates of resistance development.<\/jats:p><\/jats:sec>Methods<\/jats:title>In a large cohort of HIV<\/jats:styled-content>\u2010positive individuals, we investigated the emergence of new resistance mutations upon virological treatment failure according to the CD<\/jats:styled-content>4 count at the initiation of cART<\/jats:styled-content>.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 7918 included individuals, 6514 (82.3%), 996 (12.6%) and 408 (5.2%) started cART<\/jats:styled-content> with a CD<\/jats:styled-content>4 count \u2264\u00a0350, 351\u2013499 and \u2265\u00a0500 cells\/\u03bcL, respectively. Virological rebound occurred while on cART<\/jats:styled-content> in 488 (7.5%), 46 (4.6%) and 30 (7.4%) with a baseline CD<\/jats:styled-content>4 count \u2264\u00a0350, 351\u2013499 and \u2265\u00a0500 cells\/\u03bcL, respectively. Only four (13.0%) individuals with a baseline CD<\/jats:styled-content>4 count >\u00a0350 cells\/\u03bcL in receipt of a resistance test at viral load rebound were found to have developed new resistance mutations. This compared to 107 (41.2%) of those with virological failure who had initiated cART<\/jats:styled-content> with a CD<\/jats:styled-content>4 count <\u00a0350 cells\/\u03bcL.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>We found no evidence of increased rates of resistance development when cART<\/jats:styled-content> was initiated at CD<\/jats:styled-content>4 counts above 350 cells\/\u03bcL.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hiv.12302","type":"journal-article","created":{"date-parts":[[2015,8,26]],"date-time":"2015-08-26T05:03:29Z","timestamp":1440565409000},"page":"368-372","source":"Crossref","is-referenced-by-count":6,"title":["Virological failure and development of new resistance mutations according to CD<\/scp>4 count at combination antiretroviral therapy initiation"],"prefix":"10.1111","volume":"17","author":[{"given":"S","family":"Jose","sequence":"first","affiliation":[{"name":"Research Department of Infection and Population Health UCL London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Quinn","sequence":"additional","affiliation":[{"name":"Department of Medicine Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Dunn","sequence":"additional","affiliation":[{"name":"Medical Research Council Clinical Trials Unit at UCL London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Cox","sequence":"additional","affiliation":[{"name":"Infection and Immunity Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Sabin","sequence":"additional","affiliation":[{"name":"Research Department of Infection and Population Health UCL London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Fidler","sequence":"additional","affiliation":[{"name":"Department of Medicine Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the UK CHIC and UK HDRD Steering Committees","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,8,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0807252"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60612-7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328360d546"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1740774512440342"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.7961"},{"key":"e_1_2_8_7_1","unstructured":"World Health Organization 2013"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1105243"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1258\/095646204322637245"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3181acb630"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0075608"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000242"},{"key":"e_1_2_8_13_1","first-page":"642","article-title":"2014 Update of the drug resistance mutations in HIV\u20101","volume":"22","author":"Wensing AM","year":"2014","journal-title":"Top Antivir Med"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32832ba8ec"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1110039"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1086\/432881"},{"key":"e_1_2_8_17_1","unstructured":"AghaizuA BrownA NardoneA GillO DelpechV.HIV in the United Kingdom 2013 Report: data to end 2012. 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