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Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/µL in HIV Type 1—Infected Individuals Receiving Potent Antiretroviral Therapy

Kaufmann, Gilbert R. ; Furrer, Hansjakob ; Ledergerber, Bruno ; Perrin, Luc ; Opravil, Milos ; Vernazza, Pietro ; Cavassini, Matthias ; Bernasconi, Enos ; Rickenbach, Martin ; Hirschel, Bernard ; Battegay, Manuel

In: Clinical Infectious Diseases, 2005, vol. 41, no. 3, p. 361-372

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    Titre
    • Characteristics, Determinants, and Clinical Relevance of CD4 T Cell Recovery to <500 Cells/µL in HIV Type 1—Infected Individuals Receiving Potent Antiretroviral Therapy
    Auteur
    • Kaufmann, Gilbert R.. Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, University Hospital Basel, Basel
    • Furrer, Hansjakob. Division of Infectious Diseases, University Hospital Berne, Berne
    • Ledergerber, Bruno. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich
    • Perrin, Luc. Laboratory of Virology and Geneva University Hospital, Geneva
    • Opravil, Milos. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich
    • Vernazza, Pietro. Division of Infectious Diseases, Geneva University Hospital, Geneva
    • Cavassini, Matthias. Department of Internal Medicine, Cantonal Hospital St., Gallen, St. Gallen
    • Bernasconi, Enos. Division of Infectious Diseases and Data Center of the Swiss HIV Cohort Study, CHUV, Lausanne
    • Rickenbach, Martin. Data Center of the Swiss HIV Cohort Study, CHUV, Lausanne
    • Hirschel, Bernard. Department of Internal Medicine, Regional Hospital Lugano, Lugano, Switzerland
    • Battegay, Manuel. Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, University Hospital Basel, Basel
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • Clinical Infectious Diseases, 2005, vol. 41, no. 3, p. 361-372. The University of Chicago Press
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:295551
    Summary
    Background. The CD4 T cell count recovery in human immunodeficiency virus type 1 (HIV-1)—infected individuals receiving potent antiretroviral therapy (ART) shows high variability. We studied the determinants and the clinical relevance of incomplete CD4 T cell restoration. Methods. Longitudinal CD4 T cell count was analyzed in 293 participants of the Swiss HIV Cohort Study who had had a plasma HIV-1 RNA load <1000 copies/mL for ⩾5 years. CD4 T cell recovery was stratified by CD4 T cell count 5 years after initiation of ART (⩾500 cells/µL was defined as a complete response, and <500 cells/µL was defined as an incomplete response). Determinants of incomplete responses and clinical events were evaluated using logistic regression and survival analyses. Results. The median CD4 T cell count increased from 180 cells/µL at baseline to 576 cells/µL 5 years after ART initiation. A total of 35.8% of patients were incomplete responders, of whom 47.6% reached a CD4 T cell plateau <500 cells/µL. Centers for Disease Control and Prevention HIV-1 disease category B and/or C events occurred in 21% of incomplete responders and in 14.4% of complete responders (P > .05). Older age (adjusted odds ratio [aOR], 1.71 per 10-year increase; 95% confidence interval [CI], 1.21-2.43), lower baseline CD4 T cell count (aOR, 0.37 per 100-cell increase; 95% CI, 0.28-0.49), and longer duration of HIV infection (aOR, 2.39 per 10-year increase; 95% CI, 1.19-4.81) were significantly associated with a CD4 T cell count <500 cells/µL at 5 years. The median increases in CD4 T cell count after 3-6 months of ART were smaller in incomplete responders (P < .001) and predicted, in conjunction with baseline CD4 T cell count and age, incomplete response with 80% sensitivity and 72% specificity. Conclusion. Individuals with incomplete CD4 T cell recovery to <500 cells/µL had more advanced HIV-1 infection at baseline. CD4 T cell changes during the first 3-6 months of ART already reflect the capacity of the immune system to replenish depleted CD4 T lymphocytes