title: CD4 cell counts of 800 cells/mm3 or greater after 7 years of highly active antiretroviral therapy are feasible in most patients starting with 350 cells/mm3 or greater.
abstract: OBJECTIVE
  CD4 cell count changes in therapy-naive patients were investigated during 7 years of highly active antiretroviral therapy (HAART) in an observational cohort.
  
  
  METHODS
  Three endpoints were studied: (1) time to >or=800 CD4 cells/mm in 5299 therapy-naive patients starting HAART, (2) CD4 cell count changes during 7 years of uninterrupted HAART in a subset of 544 patients, and (3) reaching a plateau in CD4 cell restoration after 5 years of HAART in 366 virologically suppressed patients.
  
  
  RESULTS
  Among patients with <50, 50 to 200, 200 to 350, 350 to 500, and >or=500 CD4 cells/mm at baseline, respectively, 20%, 26%, 46%, 73%, and 87% reached >or=800 CD4 cells/mm within 7 years of starting HAART. Periods with HIV RNA levels >500 copies/mL and age >or=50 years were associated with lesser increases in CD4 cell counts between 6 months and 7 years. Having reached >or=800 CD4 cells/mm at 5 years, age >or=50 years, and >or=1 HIV RNA measurement >1000 copies/mL between 5 and 7 years were associated with a plateau in CD4 cell restoration.
  
  
  CONCLUSIONS
  Restoration to CD4 cell counts >or=800 cells/mm is feasible within 7 years of HAART in most HIV-infected patients starting with >or=350 cells/mm and achieving sufficient suppression of viral replication. Particularly in patients >or=50 years of age, it may be beneficial to start earlier than current guidelines recommend.
authors.affiliation: HIV Monitoring Foundation, Amsterdam, The Netherlands. l.a.gras@amc.uva.nl
authors.forename: Luuk
authors.initials: L
authors.lastname: Gras
authors.forename: Anouk M
authors.initials: AM
authors.lastname: Kesselring
authors.forename: James T
authors.initials: JT
authors.lastname: Griffin
authors.forename: Ard I
authors.initials: AI
authors.lastname: van Sighem
authors.forename: Christophe
authors.initials: C
authors.lastname: Fraser
authors.forename: Azra C
authors.initials: AC
authors.lastname: Ghani
authors.forename: Frank
authors.initials: F
authors.lastname: Miedema
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Joep M A
authors.initials: JM
authors.lastname: Lange
authors.forename: Frank
authors.initials: F
authors.lastname: de Wolf
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents