Long-term CD4+ lymphocyte response following HAART initiation in a U.S. Military prospective cohort.
BACKGROUND
Among HIV-infected persons initiating highly active antiretroviral therapy (HAART), early CD4+ lymphocyte count increases are well described. However, whether CD4+ levels continue to increase or plateau after 4-6 years is controversial.


METHODS
To address this question and identify other determinants of CD4+ response, we analyzed data for 1,846 persons from a prospective HIV military cohort study who initiated HAART, who had post-HAART CD4+ measurements, and for whom HIV seroconversion (SC) date was estimated.


RESULTS
CD4+ count at HAART initiation was ≤ 200 cells/mm3 for 23%, 201-349 for 31%, 350-499 for 27%, and ≥500 for 19%. The first 6 months post-HAART, the greatest CD4+ increases (93-151 cells) occurred, with lesser increases (22-36 cells/year) through the first four years. Although CD4+ changes for the entire cohort were relatively flat thereafter, HIV viral load (VL) suppressors showed continued increases of 12-16 cells/year. In multivariate analysis adjusting for baseline CD4+ and post-HAART time interval, CD4+ responses were poorer in those with: longer time from HIV SC to HAART start, lower pre-HAART CD4+ nadir, higher pre-HAART VL, and clinical AIDS before HAART (P < 0.05).


CONCLUSIONS
Small but positive long-term increases in CD4+ count in virally suppressed patients were observed. CD4+ response to HAART is influenced by multiple factors including duration of preceding HIV infection, and optimized if treatment is started with virally suppressive therapy as early as possible.
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA. lifso001@umn.edu
Alan R
AR
Lifson
Elizabeth M
EM
Krantz
Lynn E
LE
Eberly
Matthew J
MJ
Dolan
Vincent C
VC
Marconi
Amy C
AC
Weintrob
Nancy F
NF
Crum-Cianflone
Anuradha
A
Ganesan
Patricia L
PL
Grambsch
Brian K
BK
Agan
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