Sub-optimal CD4 recovery on long-term suppressive highly active antiretroviral therapy is associated with favourable outcome

Nur F. Önen, E. T. Overton, R. Presti, C. Blair, W. G. Powderly, K. Mondy

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Objectives: To examine risk factors for sub-optimal CD4 recovery on suppressive highly active antiretroviral therapy (HAART) and assess long-term clinical and immunological outcomes. Methods: Retrospective analysis of 286 HIV-positive patients from a university clinic who initiated HAART with CD4 count <350 cells/μL between January 1996 and July 2006 and achieved ≥52 weeks of viral suppression (VS). Sub-optimal and optimal CD4 count recovery were defined by gains of <150 and ≥150 cells/μL during the first year of VS, respectively. Risk factors were analysed by multivariate logistic regression and markers of immune maturation and activation were evaluated prospectively for a sub-group of patients with prolonged (>5 years) VS. Results: One hundred and two (36%) patients had sub-optimal CD4 recovery. Male gender, lower pre-HAART viral load, HAART toxicity and use of opportunistic infection (OI) prophylaxis were independent risk factors on multivariate analysis (P < 0.05). Outcomes of duration of VS on HAART (4 years), new OI events (1%) and mortality (5%) were similar between groups. Markers of immune maturation and activation were higher among patients with sub-optimal CD4 recovery (P < 0.05). Conclusions: Among HIV-positive patients with long-term VS, sub-optimal CD4 recovery was common but morbidity and mortality remained low. In addition, persistent CD4 T-cell activation appeared to blunt long-term CD4 gains.

Original languageEnglish (US)
Pages (from-to)439-446
Number of pages8
JournalHIV Medicine
Volume10
Issue number7
DOIs
StatePublished - 2009

Keywords

  • Sub-optimal CD4 recovery
  • Suppressive HAART
  • T-cell activation

ASJC Scopus subject areas

  • Health Policy
  • Infectious Diseases
  • Pharmacology (medical)

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