Factors influencing increases in CD4 cell counts of HIV-positive persons receiving long-term highly active antiretroviral therapy

Background. Highly active antiretroviral therapy (HAART) results in an improvement in immunologic function. We sought to investigate the factors associated with increases in CD4 cell count among human immunodeficiency virus (HIV)-positive antiretroviral-naive patients starting HAART. Methods. Five hundred ninety-six subjects were followed for a median of 2.5 years (interquartile range, 1.0-4.0 years). Factors associated with changes in CD4 cell counts in the first 3 months of HAART and from 3 months onwards were analyzed. Results. After 6, 12, and 24 months of HAART, the median increases in CD4 cell counts were 114, 181, and 248 cells/mm(3), respectively; 84%, 84%, and 80% of subjects had a virus load of <400 copies/mL during the same periods. White ethnicity, higher pre-HAART virus load, and lower pre-HAART CD4 and CD8 cell counts were associated with greater increases in CD4 cell counts during the first 3 months of HAART. From 3 months onward, a greater cumulative proportion of time spent with virus load <400 copies/mL was associated with a more favorable change in CD4 cell count (an average increase of 5.2 cells/mm(3)/year [95% confidence interval [CI], 3.8-6.7 cells/mm(3)/year] for each extra 10% cumulative time spent with a virus load <400 copies/mL) (P < .0001). For every 100 cells/mm(3) higher in baseline CD4 cell count, the increase was 6 cells/mm(3)/year less (95% CI, 2-11 cells/mm(3)/year) (P = .02). Sex, risk group, age, and HAART regimen were not associated with increases in CD4 cell counts. Conclusions. These findings emphasize the importance of maintaining virological suppression and suggest other factors that influence long-term CD4 cell response.