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Long-term CD4+ lymphocyte response following HAART initiation in a U.S. Military prospective cohort.

Lifson AR, Krantz EM, Eberly LE, Dolan MJ, Marconi VC, Weintrob AC, Crum-Cianflone NF, Ganesan A, Grambsch PL, Agan BK, Infectious Disease Clinical Research Program (IDCRP) HIV Working Gro - AIDS Res Ther (2011)

Bottom Line: The first 6 months post-HAART, the greatest CD4+ increases (93-151 cells) occurred, with lesser increases (22-36 cells/year) through the first four years.Although CD4+ changes for the entire cohort were relatively flat thereafter, HIV viral load (VL) suppressors showed continued increases of 12-16 cells/year.Small but positive long-term increases in CD4+ count in virally suppressed patients were observed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA. lifso001@umn.edu

ABSTRACT

Background: Among HIV-infected persons initiating highly active antiretroviral therapy (HAART), early CD4+ lymphocyte count increases are well described. However, whether CD4+ levels continue to increase or plateau after 4-6 years is controversial.

Methods: To address this question and identify other determinants of CD4+ response, we analyzed data for 1,846 persons from a prospective HIV military cohort study who initiated HAART, who had post-HAART CD4+ measurements, and for whom HIV seroconversion (SC) date was estimated.

Results: CD4+ count at HAART initiation was ≤ 200 cells/mm3 for 23%, 201-349 for 31%, 350-499 for 27%, and ≥500 for 19%. The first 6 months post-HAART, the greatest CD4+ increases (93-151 cells) occurred, with lesser increases (22-36 cells/year) through the first four years. Although CD4+ changes for the entire cohort were relatively flat thereafter, HIV viral load (VL) suppressors showed continued increases of 12-16 cells/year. In multivariate analysis adjusting for baseline CD4+ and post-HAART time interval, CD4+ responses were poorer in those with: longer time from HIV SC to HAART start, lower pre-HAART CD4+ nadir, higher pre-HAART VL, and clinical AIDS before HAART (P < 0.05).

Conclusions: Small but positive long-term increases in CD4+ count in virally suppressed patients were observed. CD4+ response to HAART is influenced by multiple factors including duration of preceding HIV infection, and optimized if treatment is started with virally suppressive therapy as early as possible.

No MeSH data available.


Related in: MedlinePlus

CD4+ Response Curve After HAART Initiation for All Participants, U.S. Military HIV Natural History Study.
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Figure 1: CD4+ Response Curve After HAART Initiation for All Participants, U.S. Military HIV Natural History Study.

Mentions: Figure 1 shows the CD4+ count response after HAART initiation for all participants in this analysis. For the first 6 months after HAART initiation, the average increase in CD4+ count was 129.9 cells (95% CI 122.0, 137.8). For the second phase (0.5-4.0 years) after HAART, the average annual increase was 29.1 cells (95% CI 24.5, 33.7). For the third phase (4.0-12.0 years), the average annual change was -0.4 cells (95% CI -4.5, +3.6).


Long-term CD4+ lymphocyte response following HAART initiation in a U.S. Military prospective cohort.

Lifson AR, Krantz EM, Eberly LE, Dolan MJ, Marconi VC, Weintrob AC, Crum-Cianflone NF, Ganesan A, Grambsch PL, Agan BK, Infectious Disease Clinical Research Program (IDCRP) HIV Working Gro - AIDS Res Ther (2011)

CD4+ Response Curve After HAART Initiation for All Participants, U.S. Military HIV Natural History Study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3037838&req=5

Figure 1: CD4+ Response Curve After HAART Initiation for All Participants, U.S. Military HIV Natural History Study.
Mentions: Figure 1 shows the CD4+ count response after HAART initiation for all participants in this analysis. For the first 6 months after HAART initiation, the average increase in CD4+ count was 129.9 cells (95% CI 122.0, 137.8). For the second phase (0.5-4.0 years) after HAART, the average annual increase was 29.1 cells (95% CI 24.5, 33.7). For the third phase (4.0-12.0 years), the average annual change was -0.4 cells (95% CI -4.5, +3.6).

Bottom Line: The first 6 months post-HAART, the greatest CD4+ increases (93-151 cells) occurred, with lesser increases (22-36 cells/year) through the first four years.Although CD4+ changes for the entire cohort were relatively flat thereafter, HIV viral load (VL) suppressors showed continued increases of 12-16 cells/year.Small but positive long-term increases in CD4+ count in virally suppressed patients were observed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA. lifso001@umn.edu

ABSTRACT

Background: Among HIV-infected persons initiating highly active antiretroviral therapy (HAART), early CD4+ lymphocyte count increases are well described. However, whether CD4+ levels continue to increase or plateau after 4-6 years is controversial.

Methods: To address this question and identify other determinants of CD4+ response, we analyzed data for 1,846 persons from a prospective HIV military cohort study who initiated HAART, who had post-HAART CD4+ measurements, and for whom HIV seroconversion (SC) date was estimated.

Results: CD4+ count at HAART initiation was ≤ 200 cells/mm3 for 23%, 201-349 for 31%, 350-499 for 27%, and ≥500 for 19%. The first 6 months post-HAART, the greatest CD4+ increases (93-151 cells) occurred, with lesser increases (22-36 cells/year) through the first four years. Although CD4+ changes for the entire cohort were relatively flat thereafter, HIV viral load (VL) suppressors showed continued increases of 12-16 cells/year. In multivariate analysis adjusting for baseline CD4+ and post-HAART time interval, CD4+ responses were poorer in those with: longer time from HIV SC to HAART start, lower pre-HAART CD4+ nadir, higher pre-HAART VL, and clinical AIDS before HAART (P < 0.05).

Conclusions: Small but positive long-term increases in CD4+ count in virally suppressed patients were observed. CD4+ response to HAART is influenced by multiple factors including duration of preceding HIV infection, and optimized if treatment is started with virally suppressive therapy as early as possible.

No MeSH data available.


Related in: MedlinePlus