Nikos Pantazis1, Vasilios Papastamopoulos2, Vasilios Paparizos3, Simeon Metallidis4, Georgios Adamis5, Anastasia Antoniadou6, Mina Psichogiou7, Maria Chini8, Helen Sambatakou9, Nikolaos V Sipsas10, Charalambos Gogos11, Georgios Chrysos12, Periklis Panagopoulos13, Olga Katsarou14, Achilleas Gikas15, Giota Touloumi1. 1. Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School. 2. Division of Infectious Diseases, 5th Department of Internal Medicine, Evangelismos General Hospital of Athens. 3. AIDS Unit, Clinic of Venereologic & Dermatologic Diseases, National and Kapodistrian University of Athens, Medical School, Syngros Hospital. 4. 1st Internal Medicine Department, Infectious Diseases Unit, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki. 5. 1st Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens G. Gennimatas. 6. 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital. 7. 1st Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School. 8. 3rd Department Of Internal Medicine - Infectious Diseases Unit, Red Cross General Hospital. 9. HIV Unit, 2nd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Hippokration University General Hospital. 10. Infectious Diseases Unit, Department of Pathophysiology, Laikon Athens General Hospital and National and Kapodistrian University of Athens, Medical School, Athens. 11. Department of Internal Medicine & Infectious Diseases, Patras University General Hospital, Patras. 12. Infectious Diseases Unit, Tzaneion General Hospital of Piraeus, Athens. 13. Infectious Diseases Unit, 2nd University Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis. 14. Blood Centre, National Reference Centre for Congenital Bleeding Disorders, Laikon Athens General Hospital and Medical School, National and Kapodistrian University of Athens, Athens. 15. Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
Abstract
OBJECTIVE: Combined antiretroviral treatment (cART) results in profound immunologic improvement, but it is unclear whether CD4 cell counts return to levels similar to those of HIV-negative individuals. We explore long-term CD4 cell count evolution post-cART and its association with baseline levels, virologic suppression, pre-cART cumulative viremia and other factors. DESIGN: Data were derived from the AMACS. Included individuals were adults who started cART, at least 2003, while previously ART-naive. METHODS: Changes in CD4 cell counts were modeled through piecewise linear mixed models. RESULTS: A total of 3405 individuals were included. The majority was male (86.0%), homosexual (58.8%) with median (IQR) age at cART initiation 36 (31-44) years and a median (IQR) follow-up of 3.9 (2.0-6.9) years. Most persons (57%) starting cART with less than 200 cells/μl did not reach 600 cells/μl after 7 years of treatment. Those starting cART with 200-349 CD4 cells/μl could reach 600 cells/μl within less than 2 years of fully suppressive treatment. Probability of CD4 normalization (i.e. >800 cells/μl) after 7 years of suppressive treatment was 24 and 46% for those starting treatment with less than 200 or 200-349 CD4 cells/μl, respectively. Lower pre-cART cumulative viremia was associated with faster CD4 recovery. CD4 cell count increases after 4 years were either insignificant or very slow, irrespectively of baseline levels. CONCLUSION: cART initiation before CD4 cell count drops below 350 cells/μl is crucial for achieving normal CD4 levels. These findings underline the importance of timely diagnosis and cART initiation as the risk of both AIDS and non-AIDS-related morbidity/mortality remains increased in patients with incomplete CD4 recovery.
OBJECTIVE: Combined antiretroviral treatment (cART) results in profound immunologic improvement, but it is unclear whether CD4 cell counts return to levels similar to those of HIV-negative individuals. We explore long-term CD4 cell count evolution post-cART and its association with baseline levels, virologic suppression, pre-cART cumulative viremia and other factors. DESIGN: Data were derived from the AMACS. Included individuals were adults who started cART, at least 2003, while previously ART-naive. METHODS: Changes in CD4 cell counts were modeled through piecewise linear mixed models. RESULTS: A total of 3405 individuals were included. The majority was male (86.0%), homosexual (58.8%) with median (IQR) age at cART initiation 36 (31-44) years and a median (IQR) follow-up of 3.9 (2.0-6.9) years. Most persons (57%) starting cART with less than 200 cells/μl did not reach 600 cells/μl after 7 years of treatment. Those starting cART with 200-349 CD4 cells/μl could reach 600 cells/μl within less than 2 years of fully suppressive treatment. Probability of CD4 normalization (i.e. >800 cells/μl) after 7 years of suppressive treatment was 24 and 46% for those starting treatment with less than 200 or 200-349 CD4 cells/μl, respectively. Lower pre-cART cumulative viremia was associated with faster CD4 recovery. CD4 cell count increases after 4 years were either insignificant or very slow, irrespectively of baseline levels. CONCLUSION: cART initiation before CD4 cell count drops below 350 cells/μl is crucial for achieving normal CD4 levels. These findings underline the importance of timely diagnosis and cART initiation as the risk of both AIDS and non-AIDS-related morbidity/mortality remains increased in patients with incomplete CD4 recovery.
Authors: Carl J Fichtenbaum; Heather J Ribaudo; Jorge Leon-Cruz; Edgar T Overton; Markella V Zanni; Carlos D Malvestutto; Judith A Aberg; Emma M Kileel; Kathleen V Fitch; Marije Van Schalkwyk; Nagalingeswaran Kumarasamy; Esteban Martinez; Breno Riegel Santos; Yvetot Joseph; Janet Lo; Sue Siminski; Kathleen Melbourne; Craig A Sponseller; Patrice Desvigne-Nickens; Gerald S Bloomfield; Judith S Currier; Udo Hoffmann; Pamela S Douglas; Steven K Grinspoon Journal: J Infect Dis Date: 2020-07-09 Impact factor: 7.759
Authors: Federico Perdomo-Celis; David Arcia-Anaya; Juan Carlos Alzate; Paula A Velilla; Francisco J Díaz; Maria Paulina Posada; María T Rugeles; Natalia A Taborda Journal: AIDS Res Ther Date: 2022-09-14 Impact factor: 2.846