title: Long-term follow-up of HIV-infected individuals who have significant increases in CD4+ cell counts during antiretroviral therapy.
abstract: BACKGROUND
  Descriptions of the durability and consequences of immune reconstitution in patients who start highly active antiretroviral therapy (HAART) while severely immunosuppressed are limited.
  
  
  METHODS
  Patients with previous CD4+ cell counts <50 cells/mm3, all of whom had HAART-induced increases in CD4+ cell counts of >100 cells/mm3 on 2 separate occasions (measured sequentially at least 4 weeks apart), were enrolled in a prospective trial and observed every 16-32 weeks. Evaluations included assessments for new opportunistic complications, virologic (human immunodeficiency virus [HIV] RNA load) and immunologic (CD4+ cell count) responses, or death.
  
  
  RESULTS
  The median follow-up duration for 612 subjects was 184 weeks (range, 8-216 weeks). The rate of increase in CD4+ cell counts was approximately 5.9 cells/mm3 every 8 weeks, with the degree of increase associated with the baseline HIV RNA load (<500 vs. > or =500 copies/mL). Subsequent measurements of virologic suppression based on HIV RNA levels were also associated with predicted CD4+ cell responses. Thirty-three AIDS-defining illnesses were reported (1.75 events per 100 person-years of follow-up); >40% (14 cases) occurred with higher than expected CD4+ cell counts.
  
  
  CONCLUSIONS
  CD4+ cell count increases are related to virological control, with continuing increases seen in individuals who are immunosuppressed. Opportunistic illnesses and/or complications are infrequent but can occur at any time, even in patients who maintained an elevated CD4+ cell count.
authors.affiliation: Division of Infectious Diseases, Ohio State University, Columbus, OH 43210, USA. koletar.1@osu.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Koletar
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: Julia
authors.initials: J
authors.lastname: Wu
authors.forename: J Allen
authors.initials: JA
authors.lastname: McCutchan
authors.forename: Susan E
authors.initials: SE
authors.lastname: Cohn
authors.forename: Robert L
authors.initials: RL
authors.lastname: Murphy
authors.forename: Howard M
authors.initials: HM
authors.lastname: Lederman
authors.forename: Judith S
authors.initials: JS
authors.lastname: Currier
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013997:Time Factors