Journal Article

Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/µL in HIV Type 1—Infected Individuals Receiving Potent Antiretroviral Therapy

Gilbert R. Kaufmann, Hansjakob Furrer, Bruno Ledergerber, Luc Perrin, Milos Opravil, Pietro Vernazza, Matthias Cavassini, Enos Bernasconi, Martin Rickenbach, Bernard Hirschel and Manuel Battegay

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 41, issue 3, pages 361-372
Published in print August 2005 | ISSN: 1058-4838
Published online August 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/431484
Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/µL in HIV Type 1—Infected Individuals Receiving Potent Antiretroviral Therapy

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  • Immunology
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  • Microbiology

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Background. The CD4 T cell count recovery in human immunodeficiency virus type 1 (HIV-1)—infected individuals receiving potent antiretroviral therapy (ART) shows high variability. We studied the determinants and the clinical relevance of incomplete CD4 T cell restoration.

Methods. Longitudinal CD4 T cell count was analyzed in 293 participants of the Swiss HIV Cohort Study who had had a plasma HIV-1 RNA load <1000 copies/mL for ⩾5 years. CD4 T cell recovery was stratified by CD4 T cell count 5 years after initiation of ART (⩾500 cells/µL was defined as a complete response, and <500 cells/µL was defined as an incomplete response). Determinants of incomplete responses and clinical events were evaluated using logistic regression and survival analyses.

Results. The median CD4 T cell count increased from 180 cells/µL at baseline to 576 cells/µL 5 years after ART initiation. A total of 35.8% of patients were incomplete responders, of whom 47.6% reached a CD4 T cell plateau <500 cells/µL. Centers for Disease Control and Prevention HIV-1 disease category B and/or C events occurred in 21% of incomplete responders and in 14.4% of complete responders (P > .05). Older age (adjusted odds ratio [aOR], 1.71 per 10-year increase; 95% confidence interval [CI], 1.21–2.43), lower baseline CD4 T cell count (aOR, 0.37 per 100-cell increase; 95% CI, 0.28–0.49), and longer duration of HIV infection (aOR, 2.39 per 10-year increase; 95% CI, 1.19–4.81) were significantly associated with a CD4 T cell count <500 cells/µL at 5 years. The median increases in CD4 T cell count after 3–6 months of ART were smaller in incomplete responders (P < .001) and predicted, in conjunction with baseline CD4 T cell count and age, incomplete response with 80% sensitivity and 72% specificity.

Conclusion. Individuals with incomplete CD4 T cell recovery to <500 cells/µL had more advanced HIV-1 infection at baseline. CD4 T cell changes during the first 3–6 months of ART already reflect the capacity of the immune system to replenish depleted CD4 T lymphocytes.

Journal Article.  5103 words.  Illustrated.

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

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