Risk Factors for Low CD4⁺ Count Recovery Despite Viral Suppression among Participants Initiating Antiretroviral Treatment with CD4⁺ Counts > 500 Cells/mm³: Findings from the Strategic Timing of AntiRetroviral Therapy (START) Trial

Background:Low CD4+ recovery among HIV-positive individuals who achieve virologic suppression is common but has not been studied among individuals initiating treatment at CD4+ counts of >500 cells/mm3.Setting:United States, Africa, Asia, Europe and Israel, Australia, Latin America.Methods:Among participants randomized to immediate antiretroviral therapy (ART) in the Strategic Timing of AntiRetroviral Therapy trial, low CD4+ recovery was defined as a CD4+ increase of <50 cells/mm3 from baseline after 8 months despite viral load of ≤200 copies/mL. Risk factors for low recovery were investigated with logistic regression.Results:Low CD4+ recovery was observed in 39.7% of participants. Male sex [odds ratio (OR), 1.53; P = 0.007], lower screening CD4+ cell counts (OR, 1.09 per 100 fewer cells/mm3; P = 0.004), higher baseline CD8+ cell counts (OR, 1.05 per 100 more cells/mm3; P < 0.001), and lower HIV RNA levels (OR, 1.93 per log10 decrease; P < 0.001) were associated with low CD4+ recovery. D-dimer had a quadratic association with low CD4+ recovery, with lowest odds occurring at 0.32 g/mL. At lower HIV RNA levels, the odds of low CD4+ recovery were elevated across the levels of screening CD4+ count; but at higher HIV RNA levels, the odds of low CD4+ recovery were higher among those with lower vs. higher screening CD4+.Conclusions:Low CD4+ recovery is frequent among participants starting ART at high CD4+ counts. Risk factors include male sex, lower screening CD4+ cell counts, higher CD8+ cell counts, and lower HIV RNA levels. More follow-up is required to determine the impact of low CD4+ recovery on clinical outcomes

Risk for opportunistic disease and death after reinitiating continuous antiretroviral therapy in patients with HIV previously receiving episodic therapy: a randomized trial.

Collaboratore per la suddetta ricerca multicentrica in quanto membro di SMART Study Grou

Interruption of antiretroviral therapy is associated with increased plasma cystatin C.

Collaboratore della suddetta ricerca in quanto membro del INSIGHT SMART Study Grou