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Characteristics, determinants, and clinical relevance of CD4 T cell recovery to <500 cells/microL in HIV type 1-infected individuals receiving potent antiretroviral therapy.
Clin Infect Dis 2005; 41(3):361-72CI

Abstract

BACKGROUND

The CD4 T cell count recovery in human immunodeficiency virus type 1 (HIV-1)-infected individuals receiving potent antiretroviral therapy (ART) shows high variability. We studied the determinants and the clinical relevance of incomplete CD4 T cell restoration.

METHODS

Longitudinal CD4 T cell count was analyzed in 293 participants of the Swiss HIV Cohort Study who had had a plasma HIV-1 RNA load <1000 copies/mL for > or =5 years. CD4 T cell recovery was stratified by CD4 T cell count 5 years after initiation of ART (> or =500 cells/microL was defined as a complete response, and <500 cells/microL was defined as an incomplete response). Determinants of incomplete responses and clinical events were evaluated using logistic regression and survival analyses.

RESULTS

The median CD4 T cell count increased from 180 cells/microL at baseline to 576 cells/microL 5 years after ART initiation. A total of 35.8% of patients were incomplete responders, of whom 47.6% reached a CD4 T cell plateau <500 cells/microL. Centers for Disease Control and Prevention HIV-1 disease category B and/or C events occurred in 21% of incomplete responders and in 14.4% of complete responders (P>.05). Older age (adjusted odds ratio [aOR], 1.71 per 10-year increase; 95% confidence interval [CI], 1.21-2.43), lower baseline CD4 T cell count (aOR, 0.37 per 100-cell increase; 95% CI, 0.28-0.49), and longer duration of HIV infection (aOR, 2.39 per 10-year increase; 95% CI, 1.19-4.81) were significantly associated with a CD4 T cell count <500 cells/microL at 5 years. The median increases in CD4 T cell count after 3-6 months of ART were smaller in incomplete responders (P<.001) and predicted, in conjunction with baseline CD4 T cell count and age, incomplete response with 80% sensitivity and 72% specificity.

CONCLUSION

Individuals with incomplete CD4 T cell recovery to <500 cells/microL had more advanced HIV-1 infection at baseline. CD4 T cell changes during the first 3-6 months of ART already reflect the capacity of the immune system to replenish depleted CD4 T lymphocytes.

Authors+Show Affiliations

Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland. kaufmanng@uhbs.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16007534

Citation

Kaufmann, Gilbert R., et al. "Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 cells/microL in HIV Type 1-infected Individuals Receiving Potent Antiretroviral Therapy." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 41, no. 3, 2005, pp. 361-72.
Kaufmann GR, Furrer H, Ledergerber B, et al. Characteristics, determinants, and clinical relevance of CD4 T cell recovery to <500 cells/microL in HIV type 1-infected individuals receiving potent antiretroviral therapy. Clin Infect Dis. 2005;41(3):361-72.
Kaufmann, G. R., Furrer, H., Ledergerber, B., Perrin, L., Opravil, M., Vernazza, P., ... Battegay, M. (2005). Characteristics, determinants, and clinical relevance of CD4 T cell recovery to <500 cells/microL in HIV type 1-infected individuals receiving potent antiretroviral therapy. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 41(3), pp. 361-72.
Kaufmann GR, et al. Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 cells/microL in HIV Type 1-infected Individuals Receiving Potent Antiretroviral Therapy. Clin Infect Dis. 2005 Aug 1;41(3):361-72. PubMed PMID: 16007534.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics, determinants, and clinical relevance of CD4 T cell recovery to <500 cells/microL in HIV type 1-infected individuals receiving potent antiretroviral therapy. AU - Kaufmann,Gilbert R, AU - Furrer,Hansjakob, AU - Ledergerber,Bruno, AU - Perrin,Luc, AU - Opravil,Milos, AU - Vernazza,Pietro, AU - Cavassini,Matthias, AU - Bernasconi,Enos, AU - Rickenbach,Martin, AU - Hirschel,Bernard, AU - Battegay,Manuel, AU - ,, Y1 - 2005/06/24/ PY - 2004/12/12/received PY - 2005/03/17/accepted PY - 2005/7/12/pubmed PY - 2006/9/26/medline PY - 2005/7/12/entrez SP - 361 EP - 72 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 41 IS - 3 N2 - BACKGROUND: The CD4 T cell count recovery in human immunodeficiency virus type 1 (HIV-1)-infected individuals receiving potent antiretroviral therapy (ART) shows high variability. We studied the determinants and the clinical relevance of incomplete CD4 T cell restoration. METHODS: Longitudinal CD4 T cell count was analyzed in 293 participants of the Swiss HIV Cohort Study who had had a plasma HIV-1 RNA load <1000 copies/mL for > or =5 years. CD4 T cell recovery was stratified by CD4 T cell count 5 years after initiation of ART (> or =500 cells/microL was defined as a complete response, and <500 cells/microL was defined as an incomplete response). Determinants of incomplete responses and clinical events were evaluated using logistic regression and survival analyses. RESULTS: The median CD4 T cell count increased from 180 cells/microL at baseline to 576 cells/microL 5 years after ART initiation. A total of 35.8% of patients were incomplete responders, of whom 47.6% reached a CD4 T cell plateau <500 cells/microL. Centers for Disease Control and Prevention HIV-1 disease category B and/or C events occurred in 21% of incomplete responders and in 14.4% of complete responders (P>.05). Older age (adjusted odds ratio [aOR], 1.71 per 10-year increase; 95% confidence interval [CI], 1.21-2.43), lower baseline CD4 T cell count (aOR, 0.37 per 100-cell increase; 95% CI, 0.28-0.49), and longer duration of HIV infection (aOR, 2.39 per 10-year increase; 95% CI, 1.19-4.81) were significantly associated with a CD4 T cell count <500 cells/microL at 5 years. The median increases in CD4 T cell count after 3-6 months of ART were smaller in incomplete responders (P<.001) and predicted, in conjunction with baseline CD4 T cell count and age, incomplete response with 80% sensitivity and 72% specificity. CONCLUSION: Individuals with incomplete CD4 T cell recovery to <500 cells/microL had more advanced HIV-1 infection at baseline. CD4 T cell changes during the first 3-6 months of ART already reflect the capacity of the immune system to replenish depleted CD4 T lymphocytes. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/16007534/Characteristics_determinants_and_clinical_relevance_of_CD4_T_cell_recovery_to_<500_cells/microL_in_HIV_type_1_infected_individuals_receiving_potent_antiretroviral_therapy_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/431484 DB - PRIME DP - Unbound Medicine ER -