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Effect of Baseline CD4 Cell Counts on the Clinical Significance of Short-Term Immunologic Response to Antiretroviral Therapy in Individuals With Virologic Suppression

Moore, DM; Harris, R; Lima, V; Hogg, B; May, M; Yip, B; Justice, A; ... Antiretroviral Therapy Cohort Coll, ; + view all (2009) Effect of Baseline CD4 Cell Counts on the Clinical Significance of Short-Term Immunologic Response to Antiretroviral Therapy in Individuals With Virologic Suppression. JAIDS-J ACQ IMM DEF , 52 (3) 357 - 363.

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Abstract

Background: Achieving virologic suppression is a clear therapeutic goal for patients receiving combination antiretroviral therapy (cART). However, the effects of immunologic responses, whether measured as CD4 count changes from baseline or CD4 counts at follow-up, in patients with virologic Suppression, have not been clearly established.Methods: Treatment-naive individuals aged >= 16 years, who initiated cART between 1998 and 2005 in participating cohorts of the ART Cohort Collaboration and achieved viral load <= 400 copies per milliliter 6 months after cART initiation, were included. We used Cox models to examine associations of CD4 change from baseline to 6 months, and absolute CD4 Counts at 6 months, with Subsequent rates of mortality and AIDS. Analyses were stratified by baseline CD4 count.Results: Among 23,679 eligible participants, the median increase in CD4 count at 6 months, and the implications of these increases for subsequent mortality and AIDS, varied with baseline CD4 Count. Mortality hazard ratios for increases of 0-50 cells per microliter, compared with >100 cells per microliter, were 1.87 (95% confidence interval: 1.28 to 2.73), 1.60 (1.13 to 2.28), 0.98 (0.58 to 1.65) and 1.24 (0.70 to 2.18) in participants with baseline CD4 cell count <50, 50-199, 200-349 and >= 350 cells per microliter, respectively In contrast, hazard ratios for mortality or AIDS associated with absolute CD4 cell counts at 6 months were similar across all but the highest baseline CD4 cell count strata.Conclusion: It is not possible to derive thresholds for change in CD4 Count that define an adequate immunologic response in individuals receiving cART. Absolute CD4 counts at 6 months are a more useful measure of immunologic response and subsequent prognosis.

Type: Article
Title: Effect of Baseline CD4 Cell Counts on the Clinical Significance of Short-Term Immunologic Response to Antiretroviral Therapy in Individuals With Virologic Suppression
Keywords: antiretroviral therapy, CD4 counts, discordant responses, immunologic response, virologic suppression, HIV-1-INFECTED PATIENTS, VIRAL LOAD, PROGNOSTIC IMPORTANCE, DISEASE PROGRESSION, AQUITAINE COHORT, HIV-INFECTION, ADULTS, VIRUS, COMBINATION, INCREASES
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/1305987
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