CD4+ Cell Count 6 Years after Commencement of Highly Active Antiretroviral Therapy in Persons with Sustained Virologic Suppression
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Open Access
- 1 February 2007
- journal article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 44 (3), 441-446
- https://doi.org/10.1086/510746
Abstract
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 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.Keywords
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