Measurement of naive CD4 cells reliably predicts potential for immune reconstitution in HIV.
BACKGROUND
Pathogenesis studies show that naive CD4 cells are preferentially depleted in lymphoid tissues during HIV infection, and studies of advanced patients suggest levels of naive CD4 cells in blood correlate to total CD4 cells after starting antiretroviral therapy (ARV). We hypothesized that measuring naive CD4 cells in blood in people at earlier stages of disease would identify those at highest risk for poor CD4 reconstitution who may benefit from earlier initiation of ARV.


RESULTS
We identified 348 patients from multiple AIDS Clinical Trials Group studies who were ARV naive, had a CD4 count between 200 and 500 cells per microliter, a measure of pretreatment-naive CD4 percent, and serial follow-up measures of CD4 count and plasma HIV RNA after starting ARV. We used logistic regression to model the ability of naive CD4 percent to predict 100 and 200 CD4 cell increases after 24 months of therapy. After controlling for baseline viral load and demographic variables, baseline naive but not total CD4 cell count strongly predicted CD4 cell increases. Lower baseline naive CD4 percent was associated with greater time spent at lower CD4 T-cell counts after initiating ARV.


CONCLUSIONS
Measurement of naive CD4 percent in patients can identify those least likely to reconstitute immunity, who may benefit from earlier ARV treatment.
Schacker
Timothy W
TW
Department of Medicine, University of Minnesota, MMC 250 516 Delaware Street SE, Minneapolis, MN 55455, USA. schacker@umn.edu
Bosch
Ronald J
RJ
Bennett
Kara
K
Pollard
Richard
R
Robbins
Gregory K
GK
Collier
Ann C
AC
Gulick
Roy M
RM
Spritzler
John
J
Mildvan
Donna
D
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008297:Male; D011379:Prognosis; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents