Journal Article

CD4<sup>+</sup> Cell Count 6 Years after Commencement of Highly Active Antiretroviral Therapy in Persons with Sustained Virologic Suppression

Richard D. Moore and Jeanne C. Keruly

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 3, pages 441-446
Published in print February 2007 | ISSN: 1058-4838
Published online February 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/510746
CD4+ Cell Count 6 Years after Commencement of Highly Active Antiretroviral Therapy in Persons with Sustained Virologic Suppression

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Background.Sustained suppression of the human immunodeficiency virus (HIV) type 1 RNA load with the use of highly active antiretroviral therapy (HAART) results in immunologic improvement, but it is not clear whether the CD4+ cell count increases to normal levels or whether it reaches a less-than-normal plateau. We characterized the increase in the CD4+ cell count in patients in clinical practice who maintained sustained viral suppression for up to 6 years.

Methods.All patients were from the Johns Hopkins HIV Clinical Cohort, a longitudinal observational study of patients receiving primary HIV care in Baltimore, Maryland, who were observed for >1 year while receiving HAART and who had sustained suppression of the HIV RNA load at <400 copies/mL. We analyzed annual change in the CD4+ cell count for up to 6 years after the start of HAART, stratified by baseline CD4+ cell counts of ≤200, 201–350, >350 cells/µL, and we assessed the development of clinical events (death and new acquired immunodeficiency syndrome-defining illness) by Kaplan-Meier analysis.

Results.A total of 655 patients were observed for a median of 46 months (range, 13–72 months). The median change from baseline to most recent CD4+ cell count was +274 cells/µL, with 92% of patients having an increase in CD4+ cell count. By 6 years, the median CD4+ cell count was 493 cells/µL among patients with baseline CD4+ cell counts ≤200 cells/µL, 508 cells/µL among those with baseline CD4+ cell counts of 201–350 cells/µL, and 829 cells/µL among those with baseline CD4+ cell counts >350 cells/µL. In addition to baseline CD4+ cell count, injection drug use and older age were associated with a lesser CD4+ cell count response, and duration of therapy was associated with a greater CD4+ cell count response.

Conclusion.Only patients with baseline CD4+ cell counts >350 cells/µL returned to nearly normal CD4+ cell counts after 6 years of follow-up. Significant increases were observed in all CD4+ cell count strata during the first year, but there was a lower plateau CD4+ cell count at lower baseline CD4+ cell strata. These data suggest that waiting to start HAART at lower CD4+ cell counts will result in the CD4+ cell count not returning to normal levels.

Journal Article.  3613 words.  Illustrated.

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

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