title: Effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy in HIV-1-positive subjects: results from ACTG 384.
abstract: OBJECTIVE
  To assess the effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy (ART).
  
  
  METHODS
  Nine hundred eighty antiretroviral-naive HIV-1+ subjects were randomized to start stavudine/didanosine or zidovudine/lamivudine with nelfinavir, efavirenz, or both nelfinavir and efavirenz.
  
  
  RESULTS
  Greater CD4 cell recovery was associated with age of 40 years or younger, female sex, higher baseline naive/memory CD4 cell ratio, higher baseline virus load (VL), and virologic suppression (VS). Most subjects who maintained an undetectable VL had a substantial increase in CD4 cell count, but 13% of the subjects did not, even after 3 years of VS. Persistent T-cell activation was associated with lower CD4 cell recovery, even in subjects who achieved VS. Initial treatment assignment did not affect total CD4 cell recovery, naive/memory CD4 cell reconstitution, or decline in T-cell activation. In addition to CD4 cell recovery, B-cell counts rose substantially after ART initiation.
  
  
  CONCLUSIONS
  In this large randomized trial, younger age, female sex, higher naive/memory CD4 cell ratio, higher baseline VL, and VS were associated with greater CD4 cell increase, whereas persistent T-cell activation was associated with impaired CD4 cell recovery after ART initiation. Initial treatment assignment did not affect CD4 cell reconstitution.
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA. rgandhi@partners.org
authors.forename: Rajesh T
authors.initials: RT
authors.lastname: Gandhi
authors.forename: John
authors.initials: J
authors.lastname: Spritzler
authors.forename: Ellen
authors.initials: E
authors.lastname: Chan
authors.forename: David M
authors.initials: DM
authors.lastname: Asmuth
authors.forename: Benigno
authors.initials: B
authors.lastname: Rodriguez
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Merigan
authors.forename: Martin S
authors.initials: MS
authors.lastname: Hirsch
authors.forename: Robert W
authors.initials: RW
authors.lastname: Shafer
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Robbins
authors.forename: Richard B
authors.initials: RB
authors.lastname: Pollard
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003710:Demography; D005260:Female; D005434:Flow Cytometry; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007156:Immunologic Memory; D008213:Lymphocyte Activation; D008297:Male; D011446:Prospective Studies; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents