title: CD4(+) T-cell recovery after initiation of antiretroviral therapy in a resource-limited setting: a prospective cohort analysis.
abstract: BACKGROUND
  CD4(+) T-cell count recovery after antiretroviral therapy (ART) initiation is associated with improved health outcomes. It is unknown how the CD4(+) T-cell counts of African HIV patients recover following ART initiation.
  
  
  METHODS
  We examined CD4(+) T-cell count recovery in a large cohort of HIV-positive patients initiating ART in Uganda between 2004 and 2011. We categorized patients according to their CD4(+) T-cell count at ART initiation. All patients received CD4(+) T-cell count evaluations on a biannual basis. We used quantile regression to model the recovery of CD4(+) T-cells during ART.
  
  
  RESULTS
  A total of 5,271 patients aged ≥14 years at baseline were included. The median number of CD4(+) T-cell count measurements was 6 (IQR 4-8), and vital status at censoring was known in 97.2% of individuals. Most CD4(+) T-cell count recovery occurred within the first 12 months, with marginal increases beyond 18 months and stabilization after 5 years. The strongest predictor of CD4(+) T-cell count recovery was baseline CD4(+) T-cell count. After 5 years on treatment, the median CD4(+) T-cell count was 334 cells/mm(3) for patients initiating ART with <100 cells/mm(3). Only those initiating ART with >200 cells/mm(3) reached a 5-year median >500 cells/mm(3). Adolescents had the most robust CD4(+) T-cell count recovery with a median increase after 12 months that was 109 cells/mm(3) greater than those initiating ART at age ≥50 years.
  
  
  CONCLUSIONS
  In individuals from a resource-limited setting, baseline CD4(+) T-cell count was highly predictive of the maximum CD4(+) T-cell count level achieved while on ART.
authors: Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
authors: Steve
authors: S
authors: Kanters
authors: Jean
authors: J
authors: Nachega
authors: Anna
authors: A
authors: Funk
authors: Barbara
authors: B
authors: Mukasa
authors: Julio S G
authors: JS
authors: Montaner
authors: Nathan
authors: N
authors: Ford
authors: Heiner C
authors: HC
authors: Bucher
authors: Edward J
authors: EJ
authors: Mills
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors