title: Elevated CD8 counts during HAART are associated with HIV virologic treatment failure.
abstract: OBJECTIVE
  To evaluate whether elevated CD8 counts are associated with increased risk of virologic treatment failure in HIV-infected individuals.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  US Military HIV Natural History Study participants who initiated highly active antiretroviral therapy (HAART) in 1996-2008 had 6- and 12-month post-HAART HIV RNA <400 copies per milliliter, ≥ 2 subsequent HIV viral loads and a baseline CD8 count were eligible (n = 817). Baseline was 12 months after the start of HAART, virologic failure (VF) was defined as confirmed HIV RNA ≥ 400 copies per milliliter, and CD8 counts ≥ 1200 cells per cubic millimeter were considered elevated. Cox models were used to examine the effect of baseline and time-updated CD8 counts on VF.
  
  
  RESULTS
  There were 216 failures for a rate of 5.6 per 100 person-years [95% confidence interval (CI): 4.9 to 6.4]. Among those initiating HAART in 2000-2008, the participants with elevated baseline CD8 counts had significantly greater risk of VF compared with those with baseline CD8 counts ≤ 600 cells per cubic millimeter [hazard ratio (HR) = 2.68, 95% CI: 1.13 to 6.35]. The participants with elevated CD8 counts at >20% of previous 6-month follow-up visits had a greater risk of failure at the current visit than those who did not (HR = 1.53, 95% CI: 1.14 to 2.06). Those with CD8 counts that increased after the start of HAART had a greater risk of failure than those with CD8 counts that decreased or remained the same (HR = 1.59, 95% CI: 1.19 to 2.13).
  
  
  CONCLUSIONS
  Initial or serial elevated CD8 counts while on HAART or an increase in CD8 counts from HAART initiation may be early warnings for future treatment failure.
authors: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors: Elizabeth M
authors: EM
authors: Krantz
authors: Katherine Huppler
authors: KH
authors: Hullsiek
authors: Jason F
authors: JF
authors: Okulicz
authors: Amy C
authors: AC
authors: Weintrob
authors: Brian K
authors: BK
authors: Agan
authors: Nancy F
authors: NF
authors: Crum-Cianflone
authors: Anuradha
authors: A
authors: Ganesan
authors: Tomas M
authors: TM
authors: Ferguson
authors: Braden R
authors: BR
authors: Hale
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