title: CD4 cell count at initiation of ART, long-term likelihood of achieving CD4 >750 cells/mm3 and mortality risk.
abstract: We sought to evaluate associations between CD4 at ART initiation (AI), achieving CD4 >750 cells/mm(3) (CD4 >750), long-term immunological recovery and survival.
  
  
  
  This was a prospective observational cohort study. We analysed data from ART-naive patients seen in 1996-2012 and followed ≥3 years after AI. We used Kaplan-Meier (KM) methods and log-rank tests to compare time to achieving CD4 >750 by CD4 at AI (CD4-AI); and Cox regression models and generalized estimating equations to identify factors associated with achieving CD4 >750 and mortality risk.
  
  
  
  Of 1327 patients, followed for a median of 7.9 years, >85% received ART for ≥75% of follow-up time; 64 died. KM estimates evaluating likelihood of CD4 >750 during 5 years of follow-up, stratified by CD4-AI <50, 50-199, 200-349, 350-499 and 500-750, were 20%, 25%, 56%, 80% and 87%, respectively (log-rank P < 0.001). In adjusted models, CD4-AI ≥200 (versus CD4-AI <200) was associated with achievement of CD4 >750 [adjusted HR (aHR) = 4.77]. Blacks were less likely than whites to achieve CD4 >750 (33% versus 49%, aHR = 0.77). Mortality rates decreased with increasing CD4-AI (P = 0.004 across CD4 strata for AIDS causes and P = 0.009 for non-AIDS death causes). Among decedents with CD4-AI ≥50, 56% of deaths were due to non-AIDS causes.
  
  
  
  Higher CD4-AI resulted in greater long-term CD4 gains, likelihood of achieving CD4 >750, longer survival and decreased mortality regardless of cause. Over 80% of persons with CD4-AI ≥350 achieved CD4 >750 by 4 years while 75% of persons with CD4-AI <200 did not. These data confirm the hazards of delayed AI and support early AI.
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL, USA f-palella@northwestern.edu.
authors.forename: F J
authors.initials: FJ
authors.lastname: Palella
authors.affiliation: Cerner Corporation, Kansas City, MO, USA.
authors.forename: C
authors.initials: C
authors.lastname: Armon
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Chmiel
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Brooks
authors.affiliation: Cerner Corporation, Kansas City, MO, USA.
authors.forename: R
authors.initials: R
authors.lastname: Hart
authors.affiliation: Eisenhower Medical Center, Rancho Mirage, CA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Lichtenstein
authors.affiliation: Department of Medicine, University of Illinois, Chicago, IL, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Novak
authors.affiliation: Infectious Disease Research Institute, Tampa, FL, USA.
authors.forename: B
authors.initials: B
authors.lastname: Yangco
authors.affiliation: Cerner Corporation, Kansas City, MO, USA.
authors.forename: K
authors.initials: K
authors.lastname: Wood
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Durham
authors.affiliation: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Buchacz
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*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents