title: Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4+ T-cell recovery once HIV-1 suppression is achieved?
abstract: OBJECTIVE
  This article compares trends in CD4 T-cell recovery and proportions achieving optimal restoration (≥500 cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors.
  
  
  METHODS
  We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4 less than 200 cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration.
  
  
  RESULTS
  Of 4024 individuals, 294 (7.3%) were classified as rapid progressors. At the same CD4 T-cell count at cART start (baseline), rapid progressors experienced faster CD4 T-cell increases than nonrapid progressors in first month [difference (95% confidence interval) in mean increase/month (square root scale): 1.82 (1.61; 2.04)], which reversed to slightly slower increases in months 1-18 [-0.05 (-0.06; -0.03)] and no significant differences in 18-60 months [-0.003 (-0.01; 0.01)]. Percentage achieving optimal restoration was significantly lower for rapid progressors than nonrapid progressors at months 12 (29.2 vs. 62.5%) and 36 (47.1 vs. 72.4%) but not at month 60 (70.4 vs. 71.8%). These differences disappeared after adjusting for baseline CD4 T-cell count: odds ratio (95% confidence interval) 0.86 (0.61; 1.20), 0.90 (0.38; 2.17) and 1.56 (0.55; 4.46) at months 12, 36 and 60, respectively.
  
  
  CONCLUSIONS
  Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4 T-cell counts than nonrapid progressors, but are less likely to achieve optimal restoration during the first 36 months after cART, mainly because of lower CD4 T-cell counts at cART initiation.
authors.affiliation: aInstituto de Salud Carlos III, Madrid, Spain bAthens University Medical School, Athens, Greece cAIDS Research Institute IrsiCaixa, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain dResearch Department of Infection and Population Health eMedical Research Council Clinical Trials Unit, University College London, London, UK fInstitute of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy gInserm, CESP Centre for Research in Epidemiology and Population Health, Epidemiology of HIV and STI Team, Le Kremlin Bicetre hUniv Paris-Sud, Le Kremlim Bicetre iUPMC Univ Paris 06 jINSERM, Paris, France kUniversitat de Vic-Central de Catalunya, UVIC-UCC, Vic lInstitució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain. *Julia Del Amo and Javier Martinez-Picado are senior coauthors of this work.
authors.forename: Inma
authors.initials: I
authors.lastname: Jarrin
authors.forename: Nikos
authors.initials: N
authors.lastname: Pantazis
authors.forename: Judith
authors.initials: J
authors.lastname: Dalmau
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
authors.forename: Ashley
authors.initials: A
authors.lastname: Olson
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
authors.forename: Faroudy
authors.initials: F
authors.lastname: Boufassa
authors.forename: Dominique
authors.initials: D
authors.lastname: Costagliola
authors.forename: Kholoud
authors.initials: K
authors.lastname: Porter
authors.forename: Juliá
authors.initials: J
authors.lastname: Blanco
authors.forename: Julia
authors.initials: J
authors.lastname: Del Amo
authors.forename: Javier
authors.initials: J
authors.lastname: Martinez-Picado
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000473:pathology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents