title: Factors associated with long-term CD4 cell recovery in HIV-infected patients on successful antiretroviral therapy.
abstract: The aim of the study was to study the factors associated with immunological recovery in HIV-infected patients with suppressed viral load.
  
  
  
  Nadir and current CD4 cell counts were recorded in 821 patients, as well as many demographic, epidemiological, lifestyle, clinical, therapeutic, genetic, laboratory, liver fibrosis and viral hepatitis parameters.
  
  
  
  The median age of the patients was 44.4 years [interquartile range (IQR) 40.3-48.0 years], the median time since HIV diagnosis was 15.3 years (IQR 10.5-18.9 years), the median time of suppressed viral load was 7.0 years (IQR 4.0-10.0 years) and the median time on the current antiretroviral regimen was 2.8 years (IQR 1.4-4.7 years). The median nadir and current CD4 counts were 193.0 (IQR 84.0-301.0) and 522.0 (IQR 361.0-760) cells/μL, respectively, separated by a median period of 10.2 years (IQR 5.9-12.9 years). The median CD4 count gain during follow-up was 317.0 (IQR 173.0-508.0) cells/μL. Many variables were associated with CD4 cell gains in univariate analyses, including age, gender, epidemiology, prior clinical conditions, fibrosis stage, transient elastometry, aspartate aminotransferase (AST), nadir CD4 count and hepatitis B and C virus infections and genotypes, as well as the durations of follow-up since nadir CD4 count, overall antiretroviral treatment, current antiretroviral regimen, protease inhibitor therapy and suppression of viral load. Multivariate analysis revealed that longer duration of HIV suppression (P < 0.0001), more advanced clinical Centers for Disease Control and Prevention (CDC) stages (P < 0.0001), younger age (P = 0.0003), hepatitis C virus genotypes 1 and 4 (P = 0.003), sexual acquisition of HIV (P = 0.004), and lower transient elastometry values (P = 0.03) were independent predictors of CD4 cell gains. Overall, the model accounted for 14.2% of the variability in CD4 count.
  
  
  
  In addition to the duration of HIV suppression, HIV-related diseases, HIV epidemiology, age, hepatitis C virus genotypes, and liver fibrosis were independently associated with long-term immunological recovery.
authors.affiliation: Infectious Diseases, Galdácano Hospital, Vizcaya, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Collazos
authors.affiliation: Biochemistry and Molecular Biology, Oviedo University School of Medicine, Oviedo, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Valle-Garay
authors.affiliation: Infectious Diseases, Hospital Universitario Central de Asturias (HUCA), Oviedo University School of Medicine, Oviedo, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Carton
authors.affiliation: Biochemistry and Molecular Biology, Oviedo University School of Medicine, Oviedo, Spain.
authors.forename: A H
authors.initials: AH
authors.lastname: Montes
authors.affiliation: Infectious Diseases, Hospital Universitario Central de Asturias (HUCA), Oviedo University School of Medicine, Oviedo, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Suarez-Zarracina
authors.affiliation: Infectious Diseases, Cabueñes Hospital, Gijón, Spain.
authors.forename: B
authors.initials: B
authors.lastname: De la Fuente
authors.affiliation: Infectious Diseases, Hospital Universitario Central de Asturias (HUCA), Oviedo University School of Medicine, Oviedo, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Asensi
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents
keywords: CD4 recovery; age; antiretroviral therapy; hepatitis C; liver fibrosis