Incomplete Peripheral CD4+ Cell Count Restoration in HIV-Infected Patients Receiving Long-Term Antiretroviral Treatment

被引:327
作者
Kelley, Colleen F. [1 ]
Kitchen, Christina M. R. [2 ]
Hunt, Peter W. [3 ]
Rodriguez, Benigno [4 ]
Hecht, Frederick M. [3 ]
Kitahata, Mari [5 ]
Crane, Heide M. [5 ]
Willig, James [6 ]
Mugavero, Michael [6 ]
Saag, Michael [6 ]
Martin, Jeffrey N. [3 ]
Deeks, Steven G. [3 ]
机构
[1] Emory Univ, Atlanta, GA 30322 USA
[2] Univ Calif Los Angeles, Los Angeles, CA USA
[3] Univ Calif San Francisco, San Francisco, CA 94143 USA
[4] Case Western Reserve Univ, Cleveland, OH 44106 USA
[5] Univ Washington, Seattle, WA 98195 USA
[6] Univ Alabama, Birmingham, AL USA
关键词
HUMAN-IMMUNODEFICIENCY-VIRUS; VIROLOGICAL SUPPRESSION; HIV-1-INFECTED PATIENTS; VIRAL SUPPRESSION; LYMPHOID-TISSUES; THERAPY; ACTIVATION; DISEASE; VIREMIA; HAART;
D O I
10.1086/597093
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Although antiretroviral therapy has the ability to fully restore a normal CD4(+) cell count (>500 cells/mm(3)) in most patients, it is not yet clear whether all patients can achieve normalization of their CD4(+) cell count, in part because no study has followed up patients for >7 years. Methods. Three hundred sixty-six patients from 5 clinical cohorts who maintained a plasma human immunodeficiency virus (HIV) RNA level <= 1000 copies/mL for at least 4 years after initiation of antiretroviral therapy were included. Changes in CD4(+) cell count were evaluated using mixed-effects modeling, spline-smoothing regression, and Kaplan-Meier techniques. Results. The majority (83%) of the patients were men. The median CD4(+) cell count at the time of therapy initiation was 201 cells/mm(3) (interquartile range, 72-344 cells/mm(3)), and the median age was 47 years. The median follow-up period was 7.5 years (interquartile range, 5.5-9.7 years). CD4(+) cell counts continued to increase throughout the follow-up period, albeit slowly after year 4. Although almost all patients (95%) who started therapy with a CD4(+) cell count >= 300 cells/mm(3) were able to attain a CD4(+) cell count >= 500 cells/mm(3), 44% of patients who started therapy with a CD4(+) cell count <100 cells/mm(3) and 25% of patients who started therapy with a CD4(+) cell count of 100-200 cells/mm(3) were unable to achieve a CD4(+) cell count >500 cells/mm(3) over a mean duration of follow-up of 7.5 years; many did not reach this threshold by year 10. Twenty-four percent of individuals with a CD4(+) cell count <500 cells/mm(3) at year 4 had evidence of a CD4(+) cell count plateau after year 4. The frequency of detectable viremia ("blips") after year 4 was not associated with the magnitude of the CD4(+) cell count change. Conclusions. A substantial proportion of patients who delay therapy until their CD4(+) cell count decreases to <200 cells/mm(3) do not achieve a normal CD4(+) cell count, even after a decade of otherwise effective antiretroviral therapy. Although the majority of patients have evidence of slow increases in their CD4(+) cell count over time, many do not. These individuals may have an elevated risk of non-AIDS-related morbidity and mortality.
引用
收藏
页码:787 / 794
页数:8
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