HIV-1 DNA as a prognostic marker of immune reconstitution and clinical outcome in patients initiating antiretroviral therapy for the first time
Bibliographic record
Abstract
Objective: This dissertation aims to evaluate the pre-cART HIV DNA burden as a predictive factor for immune reconstitution and clinical progression of the neurocognitive status of people living with HIV (PLWH). Methods: HIV DNA was isolated from peripheral blood mononuclear cells (PBMCs) and quantified using real-time PCR. Immune reconstitution was assessed over a period of up to four years. Piecewise-linear mixed models were used to describe changes in CD4 counts. The Montreal Cognitive Assessment (MOCA) scale was used to evaluate cognitive function. Results: In the immune reconstitution study, 148 PLWH were included. The highest rate of immune reconstitution was observed during the first trimester of therapy. There was a trend suggesting that higher HIV RNA levels were associated with a greater increase in CD4 counts, particularly during the first trimester of cART (difference above vs. below median: 15.1 cells/μL/month, 95% CI: -1.4 – 31.5, p = 0.073). Similarly, higher HIV DNA levels appeared to predict greater CD4 increases, particularly after the first trimester (difference above vs. below median: 1.2 cells/μL/month, 95% CI: -0.1 – 2.6, p = 0.071). The combination of high HIV DNA and RNA levels was significantly associated with a greater CD4 increase after the first trimester (difference high/high vs. low/low: 2.1 cells/μL/month, 95% CI: 0.3 – 4.0, p = 0.024). In multivariable analysis, lower baseline CD4 counts predicted a greater CD4 increase.In the cognitive assessment study, 116 virally suppressed PLWH participated (mean age: 47.6 years, 91.4% male). Of these, 60 individuals underwent re-evaluation after the COVID-19 pandemic, with a median follow-up of 3.1 years. The median MOCA score was 24 (22–26), with 35.3% of participants scoring within normal limits. A negative correlation was observed between MOCA scores and age (ρ = −0.283, p = 0.002), but not with CD4 count at diagnosis (ρ = 0.169, p = 0.071) or initial HIV RNA load (ρ = 0.02, p = 0.984). In the subgroup of participants with repeated assessments, MOCA scores were correlated with CD4 counts (ρ = 0.238, p = 0.069 in the first and ρ = 0.319, p = 0.014 in the second test). An improvement in performance was observed, with an increase in the median MOCA score from 24 to 25 (p = 0.02). Conclusions: In PLWH receiving successful treatment, pre-cART HIV DNA and HIV RNA levels serve as predictive markers of immune reconstitution. The MOCA scale can detect early changes in cognitive function in PLWH. Neurocognitive decline is associated with age and possibly CD4 levels at the time of testing, but not with baseline CD4 counts or HIV RNA or DNA levels.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".