Long-term follow-up of HIV-infected individuals who have significant increases in CD4+ cell counts during antiretroviral therapy
- PMID: 15546087
- DOI: 10.1086/424882
Long-term follow-up of HIV-infected individuals who have significant increases in CD4+ cell counts during antiretroviral therapy
Abstract
Background: Descriptions of the durability and consequences of immune reconstitution in patients who start highly active antiretroviral therapy (HAART) while severely immunosuppressed are limited.
Methods: Patients with previous CD4+ cell counts <50 cells/mm3, all of whom had HAART-induced increases in CD4+ cell counts of >100 cells/mm3 on 2 separate occasions (measured sequentially at least 4 weeks apart), were enrolled in a prospective trial and observed every 16-32 weeks. Evaluations included assessments for new opportunistic complications, virologic (human immunodeficiency virus [HIV] RNA load) and immunologic (CD4+ cell count) responses, or death.
Results: The median follow-up duration for 612 subjects was 184 weeks (range, 8-216 weeks). The rate of increase in CD4+ cell counts was approximately 5.9 cells/mm3 every 8 weeks, with the degree of increase associated with the baseline HIV RNA load (<500 vs. > or =500 copies/mL). Subsequent measurements of virologic suppression based on HIV RNA levels were also associated with predicted CD4+ cell responses. Thirty-three AIDS-defining illnesses were reported (1.75 events per 100 person-years of follow-up); >40% (14 cases) occurred with higher than expected CD4+ cell counts.
Conclusions: CD4+ cell count increases are related to virological control, with continuing increases seen in individuals who are immunosuppressed. Opportunistic illnesses and/or complications are infrequent but can occur at any time, even in patients who maintained an elevated CD4+ cell count.
Comment in
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How infrequent are opportunistic diseases and immune reconstitution syndromes among HIV-infected individuals who have favorable CD4+ cell count responses to antiretroviral therapy?Clin Infect Dis. 2005 May 1;40(9):1379-80; author reply 1380-1. doi: 10.1086/429510. Clin Infect Dis. 2005. PMID: 15825049 No abstract available.
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