Continued CD4 cell count increases in HIV-infected adults experiencing 4 years of viral suppression on antiretroviral therapy.
OBJECTIVE
To determine the extent to which HIV-infected patients, including those with advanced immunodeficiency, can reverse peripheral CD4 T-cell depletion while maintaining long-term viral suppression on highly active antiretroviral therapy.


METHODS
Cohort study.


METHODS
Four-hundred and twenty-three HIV-infected patients who initiated HAART prior to 1998 and achieved a viral load </= 1000 copies/ml by 48 weeks were evaluated for up to 4 years or until plasma HIV RNA levels increased to > 1000 copies/ml.


METHODS
CD4 count changes.


RESULTS
Among patients who maintained plasma HIV RNA levels </= 1000 copies/ml, CD4 counts continued to increase through year 4 of HAART. In the last year examined, from year 3 to 4 of HAART, mean CD4 count gains were +89 x 10(6), +86 x 10(6), +95 x 10(6), and +88 x 10(6)/l in patients with pre-therapy CD4 counts of < 50 x 10(6), 50 x 10(6)-199 x 10(6), 200 x 10(6)-349 x 10(6), and >/= 350 x 10(6)/l, respectively (all gains were significantly greater than zero; P < 0.05). Among those with a pre-therapy CD4 count of < 50 x 10(6)/l, 88% achieved a CD4 cell count of >/= 200 x 10(6)/l and 59% achieved a count of >/= 350 x 10(6)/l by year 4. Factors associated with increased CD4 cell count gains from month 3 to year 4 included lower pre-therapy CD4 cell count, younger age, female sex, and infrequent low-level viremia (versus sustained undetectable viremia).


CONCLUSIONS
Most patients who achieve and maintain viral suppression on HAART continue to experience CD4 T-cell gains through 4 years of therapy. The immune system's capacity for CD4 T lymphocyte restoration is not limited by low pre-therapy CD4 counts.
Hunt
Peter W
PW
Positive Health Program, San Francisco General Hospital, University of California, San Francisco, California, USA.
Deeks
Steven G
SG
Rodriguez
Benigno
B
Valdez
Hernan
H
Shade
Starley B
SB
Abrams
Donald I
DI
Kitahata
Mari M
MM
Krone
Melissa
M
Neilands
Torsten B
TB
Brand
Richard J
RJ
Lederman
Michael M
MM
Martin
Jeffrey N
JN
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral