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Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4 + T-cell recovery once HIV-1 suppression is achieved?
Authors
I. Jarrin Pantazis, N. Dalmau, J. Phillips, A.N. Olson, A. Mussini, C. Boufassa, F. Costagliola, D. Porter, K. Blanco, J. Del Amo, J. Martinez-Picado, J. Chene, G. Sabin, C. Walker, S. Fisher, M. Kelleher, T. Cooper, D. Finlayson, R. Bloch, M. Ramacciotti, T. Gelgor, L. Smith, D. Zangerle, R. Gill, J. Lutsar, I. Dabis, F. Thiebaut, R. Guiguet, M. Vanhems, P. Chaix, M.-L. Ghosn, J. Meyer, L. Hamouda, O. Kucherer, C. Bartmeyer, B. Antoniadou, A. Chrysos, G. Daikos, G.L. Touloumi, G. Katsarou, O. Rezza, G. Dorrucci, M. Monforte, A.D. De Luca, A. Prins, M. Geskus, R. Van Der Helm, J. Schuitemaker, H. Sannes, M. Brubakk, O. Kran, A.-M.B. Rosinska, M. Muga, R. Tor, J. De Olalla, P.G. Cayla, J. Moreno, S. Monge, S. Del Romero, J. Perez-Hoyos, S. Sonnerborg, A. Bucher, H.C. Gunthard, H. Rickenbach, M. Malyuta, R. Murphy, G. Johnson, A. Babiker, A. Pillay, D. Morrison, C. Salata, R. Mugerwa, R. Chipato, T. Amornkul, P.N. Gilmour, J. Kamali, A. Karita, E. Burns, F. Giaquinto, C. Grarup, J. Kirk, O. Bailey, H. Anne, A.V. Panteleev, A. Thorne, C. Aboulker, J.-P. Albert, J. Asandi, S. De Wit, S. Reiss, P. Gatell, J. Karpov, I. Ledergerber, B. Lundgren, J. Møller, C. Rakhmanova, A. Rockstroh, J. Sandhu, M. Dedes, N. Fenton, K. Pizzuti, D. Vitoria, M. Faggion, S. Fradette, L. Frost, R. Cartier, A. Raben, D. Schwimmer, C. Scott, M.
Publication date
1 January 2015
Publisher
Abstract
Objective: This article compares trends in CD4 + T-cell recovery and proportions achieving optimal restoration (≥500cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors. Methods: We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4 + less than 200cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration. Results: Of 4024 individuals, 294 (7.3%) were classified as rapid progressors. At the same CD4 + T-cell count at cART start (baseline), rapid progressors experienced faster CD4 + T-cell increases than nonrapid progressors in first month [difference (95% confidence interval) in mean increase/month (square root scale): 1.82 (1.61; 2.04)], which reversed to slightly slower increases in months 1-18 [-0.05 (-0.06; -0.03)] and no significant differences in 18-60 months [-0.003 (-0.01; 0.01)]. Percentage achieving optimal restoration was significantly lower for rapid progressors than nonrapid progressors at months 12 (29.2 vs. 62.5%) and 36 (47.1 vs. 72.4%) but not at month 60 (70.4 vs. 71.8%). These differences disappeared after adjusting for baseline CD4 + T-cell count: odds ratio (95% confidence interval) 0.86 (0.61; 1.20), 0.90 (0.38; 2.17) and 1.56 (0.55; 4.46) at months 12, 36 and 60, respectively. Conclusion: Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4 + T-cell counts than nonrapid progressors, but are less likely to achieve optimal restoration during the first 36 months after cART, mainly because of lower CD4 + T-cell counts at cART initiation. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved
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Last time updated on 10/02/2023