Early Postseroconversion CD4 Cell Counts Independently Predict CD4 Cell Count Recovery in HIV-1-Postive Subjects Receiving Antiretroviral Therapy

• Type of Material: Article
• Authors: Hemant Kulkarni, South Texas Veterans Health Care System; Jason F. Okulicz, Brooke Army Medical Center; Greg Grandits, University of Minnesota; Nancy F. Crum-Cianflone, Naval Medical Center San Diego; Michael L. Landrum, Brooke Army Medical Center; Braden Hale, Naval Medical Center San Diego; Glenn Wortmann, Walter Reed Army Medical Center; Edmund Tramont, National Institutes of Health; Michael Polis, National Institutes of Health; Matthew Dolan, Wilford Hall United States Air Force Medical Center; Alan R. Lifson, University of Minnesota; Brian K. Agan, Uniformed Services University of the Health Sciences; Sunil K. Ahuja, University of Texas Health Science Center; Vincent Marconi, Emory University
• Language: English
• Date: 2011-08-15
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 Lippincott Williams & Wilkins, Inc.
• Final Published Version (URL): https://dx.doi.org/10.1097/QAI.0b013e3182219113
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 57
• Issue: 5
• Start Page: 387
• End Page: 395
• Grant/Funding Information: Support for this work (IDCRP-000-03) was provided by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense program executed through the Uniformed Services University of the Health Sciences. This project has been funded in whole, or in part, with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), under Inter-Agency Agreement Y1-AI-5072. This work was also supported by the Veterans Administration Center on AIDS and HIV infection of the South Texas Veterans Health Care System, and a MERIT (R37046326) award from the NIH to S.K.A. S.K.A. is also supported by a VA MERIT award and is a recipient of the Elizabeth Glaser Scientist Award, the Burroughs Wellcome Clinical Scientist Award in Translational Research, and the Doris Duke Distinguished Clinical Scientist Award.
• Keywords: treatment response; outcomes; highly active antiretroviral therapy; predictors; CD4 count
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Immunology

Abstract

Background The relationship between CD4+ T-cell counts determined soon after seroconversion with HIV-1 (baseline CD4), nadir CD4, and CD4 levels attained during highly active antiretroviral therapy (HAART) is unknown. Methods Longitudinal, including baseline (at or soon after HIV diagnosis), intermediate (nadir), and distal (post-HAART) CD4+ T-cell counts were assessed in 1085 seroconverting subjects who achieved viral load suppression from a large well-characterized cohort. The association of baseline with post-HAART CD4+ T-cell count was determined after adjustment for other relevant covariates. Results A higher baseline CD4+ T-cell count predicted a greater post- HAART CD4+ T-cell count, independent of the nadir and other explanatory variables. Together, baseline and nadir strongly predicted the post-HAART CD4+ count such that a high baseline and lower nadir were associated with a maximal immune recovery after HAART. Likelihood of recovery of the baseline count after HAART was significantly higher when the nadir/baseline count ratio was consistently ≥0.6. Conclusions Among viral load suppressing seroconverters, the absolute CD4+ T-cell count attained post-HAART is highly dependent on both baseline and nadir CD4+ T-cell counts. These associations further support the early diagnosis and initiation of HAART among HIV-infected persons.