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The Factors Related to CD4+ T-Cell Recovery and Viral Suppression in Patients Who Have Low CD4+ T Cell Counts at the Initiation of HAART: A Retrospective Study of the National HIV Treatment Sub-Database of Zhejiang Province, China, 2014.

He L, Pan X, Dou Z, Huang P, Zhou X, Peng Z, Zheng J, Zhang J, Yang J, Xu Y, Jiang J, Chen L, Jiang J, Wang N - PLoS ONE (2016)

Bottom Line: At the end of follow-up, 727 (79.2%), 363 (39.5%) and 149 (16.2%) patients had return to ≥ 200, 350, and 500 cells/μL, respectively.The median time to return to 200-350, 350-500, ≥ 500cells/μL was 1.11, 3.33 and 6.91 years, respectively.Factors of age (aHR = 0.77, 95%CI 0.61-0.97), baseline CD4+ count (aHR = 1.60, 95%CI 1.37-1.86), initial regimens, changes in regimen (aHR = 0.58, 95%CI 0.49-0.69), and inclusion of a cotrimoxazole prophylaxis (aHR = 0.66, 95%CI 0.51-0.85) were associated with CD4+ T cell count recovery.

View Article: PubMed Central - PubMed

Affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.

ABSTRACT

Background: Since China has a unique system of delivering HIV care that includes all patients' records. The factors related to CD4+ T-cell recovery and viral suppression in patients who have low CD4+ T cell counts at the initiation of HAART are understudied in the China despite subsequent virological suppression (viral load < 50 copies/mL) is unknown.

Methods: The authors conducted a retrospective cohort study using data from the national HIV treatment sub-database of Zhejiang province to identify records of HIV+ patients. Patient records were included if they were ≥ 16 years of age, had an initial CD4 count < 100 cells/μL, were on continuous HAART for at least one year by the end of December 31, 2014; and achieved and maintained continued maximum virological suppression (MVS) (< 50 copies/ml) by 9 months after starting HAART. The primary endpoint for analysis was time to first CD4+ T cell count recovery (≥ 200, 350, 500 cells/μL). Cox proportional hazard regression was used to identify the risk factors for CD4+ T cell count recovery to key thresholds (200-350, 350-500, ≥ 500 cells/μL) by the time of last clinical follow-up (whichever occurred first), key thresholds (follow-up date for analysis), with patients still unable to reach the endpoints being censored by the end December 31, 2014 (follow-up date for analysis).

Results: Of the 918 patients who were included in the study, and the median CD4+ T cell count was 39 cells/μL at the baseline. At the end of follow-up, 727 (79.2%), 363 (39.5%) and 149 (16.2%) patients had return to ≥ 200, 350, and 500 cells/μL, respectively. Kaplan-Meier analysis demonstrated that the rate of patients with CD4+ count recovery to ≥ 200, 350, and 500 cells/μL after 1 year on HAART was 43.6, 8.6, and 2.5%, respectively, after 3 years on treatment was 90.8, 46.3, and 17.9%, respectively, and after 5 years on HAART was 97.1, 72.2, and 36.4%, respectively. The median time to return to 200-350, 350-500, ≥ 500cells/μL was 1.11, 3.33 and 6.91 years, respectively. Factors of age (aHR = 0.77, 95%CI 0.61-0.97), baseline CD4+ count (aHR = 1.60, 95%CI 1.37-1.86), initial regimens, changes in regimen (aHR = 0.58, 95%CI 0.49-0.69), and inclusion of a cotrimoxazole prophylaxis (aHR = 0.66, 95%CI 0.51-0.85) were associated with CD4+ T cell count recovery.

Conclusion: The proportion of patients with initially low CD4 counts after nine months of treatment and that achieved continuous virological suppression was greater than 70% for persons with CD4+ count ≥ 350. Conversely, only 35% of patients recovered to levels of 500 cells/μL after 5 years of treatment, and levels continued to rise significantly with further long-term HAART. Early HAART intervention will be necessary for achieving effective CD4+ T cell responses and optimal immunological function in HIV+ patients.

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The median CD4+ count increased after starting treatment as observed in the 5 years of follow-up.
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pone.0148915.g002: The median CD4+ count increased after starting treatment as observed in the 5 years of follow-up.

Mentions: Fig 2 shows the CD4+ count increased during the treatment from starting HAART to 5 years on treatment. Along with HAART duration, CD4+ count continually increased, even long term after HAART initiation. The greatest CD4+ count rapid rise was seen in the first year after receiving treatment, the median CD4+ count was 39 cells/μL at baseline, up to 143 cells/μL at 0.5 year, 185 cells/μL at 1.0 year. The median CD4+ count increased slowly after that, reaching 262 cells/μL at year 2, 299 cells/μL at year 3, 331 cells/μL at year 4, and 361 cells/μL at year 5.


The Factors Related to CD4+ T-Cell Recovery and Viral Suppression in Patients Who Have Low CD4+ T Cell Counts at the Initiation of HAART: A Retrospective Study of the National HIV Treatment Sub-Database of Zhejiang Province, China, 2014.

He L, Pan X, Dou Z, Huang P, Zhou X, Peng Z, Zheng J, Zhang J, Yang J, Xu Y, Jiang J, Chen L, Jiang J, Wang N - PLoS ONE (2016)

The median CD4+ count increased after starting treatment as observed in the 5 years of follow-up.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764673&req=5

pone.0148915.g002: The median CD4+ count increased after starting treatment as observed in the 5 years of follow-up.
Mentions: Fig 2 shows the CD4+ count increased during the treatment from starting HAART to 5 years on treatment. Along with HAART duration, CD4+ count continually increased, even long term after HAART initiation. The greatest CD4+ count rapid rise was seen in the first year after receiving treatment, the median CD4+ count was 39 cells/μL at baseline, up to 143 cells/μL at 0.5 year, 185 cells/μL at 1.0 year. The median CD4+ count increased slowly after that, reaching 262 cells/μL at year 2, 299 cells/μL at year 3, 331 cells/μL at year 4, and 361 cells/μL at year 5.

Bottom Line: At the end of follow-up, 727 (79.2%), 363 (39.5%) and 149 (16.2%) patients had return to ≥ 200, 350, and 500 cells/μL, respectively.The median time to return to 200-350, 350-500, ≥ 500cells/μL was 1.11, 3.33 and 6.91 years, respectively.Factors of age (aHR = 0.77, 95%CI 0.61-0.97), baseline CD4+ count (aHR = 1.60, 95%CI 1.37-1.86), initial regimens, changes in regimen (aHR = 0.58, 95%CI 0.49-0.69), and inclusion of a cotrimoxazole prophylaxis (aHR = 0.66, 95%CI 0.51-0.85) were associated with CD4+ T cell count recovery.

View Article: PubMed Central - PubMed

Affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China.

ABSTRACT

Background: Since China has a unique system of delivering HIV care that includes all patients' records. The factors related to CD4+ T-cell recovery and viral suppression in patients who have low CD4+ T cell counts at the initiation of HAART are understudied in the China despite subsequent virological suppression (viral load < 50 copies/mL) is unknown.

Methods: The authors conducted a retrospective cohort study using data from the national HIV treatment sub-database of Zhejiang province to identify records of HIV+ patients. Patient records were included if they were ≥ 16 years of age, had an initial CD4 count < 100 cells/μL, were on continuous HAART for at least one year by the end of December 31, 2014; and achieved and maintained continued maximum virological suppression (MVS) (< 50 copies/ml) by 9 months after starting HAART. The primary endpoint for analysis was time to first CD4+ T cell count recovery (≥ 200, 350, 500 cells/μL). Cox proportional hazard regression was used to identify the risk factors for CD4+ T cell count recovery to key thresholds (200-350, 350-500, ≥ 500 cells/μL) by the time of last clinical follow-up (whichever occurred first), key thresholds (follow-up date for analysis), with patients still unable to reach the endpoints being censored by the end December 31, 2014 (follow-up date for analysis).

Results: Of the 918 patients who were included in the study, and the median CD4+ T cell count was 39 cells/μL at the baseline. At the end of follow-up, 727 (79.2%), 363 (39.5%) and 149 (16.2%) patients had return to ≥ 200, 350, and 500 cells/μL, respectively. Kaplan-Meier analysis demonstrated that the rate of patients with CD4+ count recovery to ≥ 200, 350, and 500 cells/μL after 1 year on HAART was 43.6, 8.6, and 2.5%, respectively, after 3 years on treatment was 90.8, 46.3, and 17.9%, respectively, and after 5 years on HAART was 97.1, 72.2, and 36.4%, respectively. The median time to return to 200-350, 350-500, ≥ 500cells/μL was 1.11, 3.33 and 6.91 years, respectively. Factors of age (aHR = 0.77, 95%CI 0.61-0.97), baseline CD4+ count (aHR = 1.60, 95%CI 1.37-1.86), initial regimens, changes in regimen (aHR = 0.58, 95%CI 0.49-0.69), and inclusion of a cotrimoxazole prophylaxis (aHR = 0.66, 95%CI 0.51-0.85) were associated with CD4+ T cell count recovery.

Conclusion: The proportion of patients with initially low CD4 counts after nine months of treatment and that achieved continuous virological suppression was greater than 70% for persons with CD4+ count ≥ 350. Conversely, only 35% of patients recovered to levels of 500 cells/μL after 5 years of treatment, and levels continued to rise significantly with further long-term HAART. Early HAART intervention will be necessary for achieving effective CD4+ T cell responses and optimal immunological function in HIV+ patients.

Show MeSH
Related in: MedlinePlus