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

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.

• Authors: Alan R Lifson, Elizabeth M Krantz, Lynn E Eberly, Matthew J Dolan, Vincent C Marconi, Amy C Weintrob, Nancy F Crum-Cianflone, Anuradha Ganesan, Patricia L Grambsch, Brian K Agan, Infectious Disease Clinical Research Program (IDCRP) HIV Working Group
• Journal: AIDS research and therapy (AIDS Res Ther) Vol. 8 Issue 1 Pg. 2 (Jan 18 2011) ISSN: 1742-6405 [Electronic] England
• PMID: 21244701 (Publication Type: Journal Article)