Long-term follow-up of HIV-infected individuals who have significant increases in CD4+ cell counts during antiretroviral therapy.
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.
Koletar
Susan L
SL
Division of Infectious Diseases, Ohio State University, Columbus, OH 43210, USA. koletar.1@osu.edu
Williams
Paige L
PL
Wu
Julia
J
McCutchan
J Allen
JA
Cohn
Susan E
SE
Murphy
Robert L
RL
Lederman
Howard M
HM
Currier
Judith S
JS
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