Evolution of CD4+ T cell count in HIV-1-infected adults receiving antiretroviral therapy with sustained long-term virological suppression

Byakwaga, Helen, Murray, John M., Petoumenos, Kathy, Kelleher, Anthony D., Law, Matthew G., Boyd, Mark A., Emery, Sean, Mallon, Patrick W. and Cooper, David A. (2009) Evolution of CD4+ T cell count in HIV-1-infected adults receiving antiretroviral therapy with sustained long-term virological suppression. AIDS Research and Human Retroviruses, 25 6: 569-576. doi:10.1089/aid.2008.0149


Author Byakwaga, Helen
Murray, John M.
Petoumenos, Kathy
Kelleher, Anthony D.
Law, Matthew G.
Boyd, Mark A.
Emery, Sean
Mallon, Patrick W.
Cooper, David A.
Title Evolution of CD4+ T cell count in HIV-1-infected adults receiving antiretroviral therapy with sustained long-term virological suppression
Formatted title
Evolution of CD4+ T cell count in HIV-1-infected adults receiving antiretroviral therapy with sustained long-term virological suppression
Journal name AIDS Research and Human Retroviruses   Check publisher's open access policy
ISSN 0889-2229
1931-8405
Publication date 2009-06-17
Sub-type Article (original research)
DOI 10.1089/aid.2008.0149
Open Access Status Not yet assessed
Volume 25
Issue 6
Start page 569
End page 576
Total pages 8
Place of publication New Rochelle, NY, United States
Publisher Mary Ann Liebert
Language eng
Formatted abstract
It is not fully elucidated whether patients who receive antiretroviral therapy (ART) can maintain continued CD4 count increases. Previous studies suggested a plateau 2-4 years after treatment initiation. We aimed to characterize the evolution of CD4 counts in HIV-infected individuals receiving long-term suppressive ART, by performing a retrospective study of patients who maintained viral suppression (HIV RNA <400 copies/ml) for ≥5 years. We used linear regression models to determine for each individual whether the CD4 count continued to increase or plateau. Furthermore, we estimated whether the slope of the CD4 count for each individual became zero, which we defined as the CD4 set-point. We assessed factors associated with continued CD4 count rise, reaching a CD4 set-point and time to the CD4 set-point. Fifty-nine patients were included. The median baseline CD4 count was 238 (IQR, 120-360) cells/μl and the median duration on ART was 7.6 (IQR, 5.9-9.3) years. On ART, CD4 count continued to increase in 37 subjects (63%). Significant predictors of continued CD4 count increase included a lower baseline log10 HIV RNA (OR, 0.35; 95% CI, 0.14-0.89; p =0.026) and a shorter duration on ART (OR, 0.65; 95% CI, 0.47-0.91; p =0.021). Twenty-four (41%) subjects reached a set-point after a median 4.3 (IQR 1.8-6.4) years on ART. A lower baseline CD4 percentage was associated with both a longer time to reach the CD4 set-point and a lower CD4 count at the CD4 set-point. These findings suggest that CD4 count may continue to increase in some patients after several years of ART. Our results point to an advantage to commencing ART at higher CD4+ T cell strata. These data should be considered when estimating the optimal time to initiate ART.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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