Journal Article

Long-Term Follow-Up of HIV-Infected Individuals Who Have Significant Increases in CD4<sup>+</sup> Cell Counts during Antiretroviral Therapy

Susan L. Koletar, Paige L. Williams, Julia Wu, J. Allen McCutchan, Susan E. Cohn, Robert L. Murphy, Howard M. Lederman and Judith S. Currier

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 39, issue 10, pages 1500-1506
Published in print November 2004 | ISSN: 1058-4838
Published online November 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/424882
Long-Term Follow-Up of HIV-Infected Individuals Who Have Significant Increases in CD4+ Cell Counts during Antiretroviral Therapy

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Background. Descriptions of the durability and consequences of immune reconstitution in patients who start highly active antiretroviral therapy (HAART) while severely immunosuppressed are limited.

Methods. Patients with previous CD4+ cell counts <50 cells/mm3, all of whom had HAART-induced increases in CD4+ cell counts of >100 cells/mm3 on 2 separate occasions (measured sequentially at least 4 weeks apart), were enrolled in a prospective trial and observed every 16–32 weeks. Evaluations included assessments for new opportunistic complications, virologic (human immunodeficiency virus [HIV] RNA load) and immunologic (CD4+ cell count) responses, or death.

Results. The median follow-up duration for 612 subjects was 184 weeks (range, 8–216 weeks). The rate of increase in CD4+ cell counts was ∼5.9 cells/mm3 every 8 weeks, with the degree of increase associated with the baseline HIV RNA load (<500 vs. ⩾500 copies/mL). Subsequent measurements of virologic suppression based on HIV RNA levels were also associated with predicted CD4+ cell responses. Thirty-three AIDS-defining illnesses were reported (1.75 events per 100 person-years of follow-up); >40% (14 cases) occurred with higher than expected CD4+ cell counts.

Conclusions. CD4+ cell count increases are related to virological control, with continuing increases seen in individuals who are immunosuppressed. Opportunistic illnesses and/or complications are infrequent but can occur at any time, even in patients who maintained an elevated CD4+ cell count.

Journal Article.  3856 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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