title: Effect of baseline HIV disease parameters on CD4+ T cell recovery after antiretroviral therapy initiation in Kenyan women.
abstract: BACKGROUND
  Antiretroviral therapy (ART) for HIV infection reconstitutes the immune system and improves survival. However, the rate and extent of CD4+ T cell recovery varies widely. We assessed the impact of several factors on immune reconstitution in a large Kenyan cohort.
  
  
  RESULTS
  HIV-infected female sex workers from a longitudinal cohort, with at least 1 year of pre-ART and 6 months of post-ART follow-up (n = 79), were enrolled in the current study. The median pre-ART follow-up was 4,040 days. CD4 counts were measured biannually and viral loads where available. The median CD4 count at ART initiation was 180 cells/ul, which increased to 339 cells/ul at the most recent study visit. The rate of CD4+ T cell increase on ART was 7.91 cells/month (mean = 13, range -25.92 to 169.4). LTNP status prior to ART initiation did not associate with the rate of CD4 recovery on ART. In univariate analyses, associations were observed for CD4 recovery rate and duration of pre-ART immunosuppression (r = -0.326, p = 0.004) and CD4 nadir (r = 0.284, p = 0.012). In multivariate analysis including age, CD4 nadir, duration of HIV infection, duration of pre-ART immunosuppression, and baseline viral load, only CD4 nadir (p = 0.007) and not duration of immunosuppression (p = 0.87) remained significantly associated with the rate of CD4 recovery.
  
  
  CONCLUSIONS
  These data suggest that prior duration of immune suppression does not predict subsequent recovery once ART is initiated and confirm the previous observation that the degree of CD4 depletion prior to ART initiation is the most important determinant of subsequent immune reconstitution.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada. sijuisijali@gmail.com
authors.forename: Lyle R
authors.initials: LR
authors.lastname: McKinnon
authors.forename: Makobu
authors.initials: M
authors.lastname: Kimani
authors.forename: Charles
authors.initials: C
authors.lastname: Wachihi
authors.forename: Nico J
authors.initials: NJ
authors.lastname: Nagelkerke
authors.forename: Festus K
authors.initials: FK
authors.lastname: Muriuki
authors.forename: Anthony
authors.initials: A
authors.lastname: Kariri
authors.forename: Richard T
authors.initials: RT
authors.lastname: Lester
authors.forename: Lawrence
authors.initials: L
authors.lastname: Gelmon
authors.forename: T Blake
authors.initials: TB
authors.lastname: Ball
authors.forename: Francis A
authors.initials: FA
authors.lastname: Plummer
authors.forename: Rupert
authors.initials: R
authors.lastname: Kaul
authors.forename: Joshua
authors.initials: J
authors.lastname: Kimani
mesh_terms: D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007630:Kenya; D016014:Linear Models; D008137:Longitudinal Studies; D015999:Multivariate Analysis
chemical_list: D044966:Anti-Retroviral Agents