Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4 + T-cell recovery once HIV-1 suppression is achieved?

Inma Jarrin, Nikos Pantazis, Judith Dalmau, Andrew N. Phillips, Ashley Olson, Cristina Mussini, Faroudy Boufassa, Dominique Costagliola, Kholoud Porter, Juliá Blanco, Julia Del Amo, Javier Martinez-Picado, Genevieve Chene, Caroline Sabin, Sarah Walker, Martin Fisher, Tony Kelleher, David Cooper, Robert Finlayson, Mark BlochTim Ramacciotti, Linda Gelgor, Don Smith, Robert Zangerle, John Gill, Irja Lutsar, Francois Dabis, Rodolphe Thiebaut, Marguerite Guiguet, Philippe Vanhems, Marie Laure Chaix, Jade Ghosn, Laurence Meyer, Osamah Hamouda, Claudia Kucherer, Barbara Bartmeyer, Anastasia Antoniadou, Georgios Chrysos, Georgios L. Daikos, Giota Touloumi, Olga Katsarou, Giovanni Rezza, Maria Dorrucci, Antonella D.arminio Monforte, Andrea De Luca, Maria Prins, Ronald Geskus, Jannie Van Der Helm, Hanneke Schuitemaker, Mette Sannes, Oddbjorn Brubakk, Anne Marte Bakken Kran, Magdalena Rosinska, Roberto Muga, Jordi Tor, Patricia Garcia De Olalla, Joan Cayla, Santiago Moreno, Susana Monge, Jorge Del Romero, Santiago Perez-Hoyos, Anders Sonnerborg, Heiner C. Bucher, Huldrych Gunthard, Martin Rickenbach, Ruslan Malyuta, Gary Murphy, Anne Johnson, Abdel Babiker, Deenan Pillay, Charles Morrison, Robert Salata, Roy Mugerwa, Tsungai Chipato, Pauli N. Amornkul, Jill Gilmour, Anatoli Kamali, Etienne Karita, Fiona Burns, Carlo Giaquinto, Jesper Grarup, Ole Kirk, Heather Bailey, Alain Volny Anne, Alex Panteleev, Claire Thorne, Jean Pierre Aboulker, Jan Albert, Silvia Asandi, Stephane De Wit, Peter Reiss, Jose Gatell, Igor Karpov, Bruno Ledergerber, Jens Lundgren, Claus Møller, Aza Rakhmanova, Jurgen Rockstroh, Manjinder Sandhu, Nikos Dedes

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12 Citations (Scopus)

Abstract

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. 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.
Original languageEnglish
Pages (from-to)2323-2333
JournalAIDS
Volume29
Issue number17
DOIs
Publication statusPublished - 1 Nov 2015

Keywords

  • CD4 responses
  • HIV-viral suppression
  • rapid progression

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