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Evolution of CD4+ T-cell count in HIV-1 infected adults receiving antiretroviral therapy with sustained long-term virological suppression

Purpose of the study

It is not fully elucidated whether patients who receive combination antiretroviral therapy (cART) can maintain continued CD4+ T-cell count increases. Previous studies suggested a plateau 2–4 years after treatment initiation. We aimed to characterize the evolution of CD4+ T-cell count in HIV-infected individuals receiving long-term suppressive cART.

Methods

This is a retrospective study of patients receiving cART in an HIV clinic cohort that maintained viral suppression (HIV-RNA <400 copies/mL) for ≥5 years. We used linear regression models to determine for each individual whether CD4+ T-cell count continued to increase. Furthermore, we estimated whether the slope of CD4+ T-cell count for each individual became zero which we defined as the CD4+ set-point. Using logistic regression methods, we assessed factors associated with continued CD4+ T-cell count rise and CD4+ set-point.

Summary of results

59 patients were included. The median baseline CD4+ T-cell count was 238 (IQR, 120–360) cells/μL and the median duration on ART was 7.6 (IQR, 5.9–9.3) years. Independent predictors of continued CD4+ T-cell count increase were baseline log10 HIV-RNA (OR 0.35, 95% CI 0.14–0.89; p = 0.026) and duration on ART (OR 0.65, 95% CI 0.47–0.91; p = 0.021). The CD4+ T-cell percentage at the start of ART was a significant predictor of time to the CD4+ set point (HR 2.4, 95% CI 1.3–4.5; p < 0.01). Patients who reached a CD4+ set-point had a significantly higher baseline CD4+ T-cell percentage at the start of ART compared to those who did not reach a CD4+ set-point; 20% vs. 13% (p < 0.01, 95% CI; 0.01–0.04). The median T-cell count at the CD4+ set-point for individuals who started ART with CD4+ T-cell count ≤200 cells/μL, 201–350 cells/μL and >350 cells/μL was 616 (IQR, 579–789) cells/μL, 719 (IQR, 580–899) cells/μL and 880 (696–1057) cells/μL, respectively.

Conclusion

These findings suggest that CD4+ T-cell count continues to increase in some patients after several years of cART. Our results point to an advantage to commencing cART at higher CD4+ T-cell strata.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Byakwaga, H., Murray, J., Petoumenos, K. et al. Evolution of CD4+ T-cell count in HIV-1 infected adults receiving antiretroviral therapy with sustained long-term virological suppression. JIAS 11, P70 (2008). https://doi.org/10.1186/1758-2652-11-S1-P70

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  • DOI: https://doi.org/10.1186/1758-2652-11-S1-P70

Keywords

  • Virological Suppression
  • Logistic Regression Method
  • Infected Adult
  • Baseline Log10
  • Suppressive cART