Long-term evolution of CD4+ cell count in patients under combined antiretroviral therapy.
AIDS
; 33(10): 1645-1655, 2019 08 01.
Article
en En
| MEDLINE
| ID: mdl-31305332
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 200âcells/µl did not reach 600âcells/µl after 7 years of treatment. Those starting cART with 200-349 CD4 cells/µl could reach 600âcells/µl within less than 2 years of fully suppressive treatment. Probability of CD4 normalization (i.e. >800âcells/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 350âcells/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.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Infecciones por VIH
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Recuento de Linfocito CD4
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Terapia Antirretroviral Altamente Activa
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Antirretrovirales
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Año:
2019
Tipo del documento:
Article