Dynamic Visual Display of Treatment Response in HIV-Infected Adults

Abstract

Background: Using a dynamic visual display, we examine the changes in human immunodeficiency virus type 1 (HIV-1) plasma viral load and CD4 cell count for 5 years after antiretroviral therapy initiation in a large cohort of patients with HIV.

Methods: Patients at a Centers for AIDS Research Network of Integrated Clinical Systems site who initiated combination antiretroviral therapy between 1 January 2000 and 31 December 2012 were followed for 5 years for HIV-1 plasma viral load, CD4 cell count, and mortality. The joint distribution of CD4 cell count and viral load over time was depicted in an animated display using a bivariate kernel smoother.

Results: Within days of therapy initiation, many patients had a suppressed viral load and their median CD4 cell count had increased. However, the median CD4 cell count remained below normal levels throughout follow-up period and the proportion of patients with high viral load occasionally increased, even years after therapy initiation.

Conclusions: The dramatic changes in viral load and CD4 cell count after therapy initiation highlight the overwhelming effectiveness of antiretroviral therapy in the modern era. However, this work also emphasizes the need for pharmaceutical or behavioral interventions to prevent virologic failure and to stimulate complete recovery of normal CD4 cell count.

Keywords: HIV/AIDS; antiretroviral therapy.

Figure 1.

Joint distribution of CD4 cell count and viral load at 30 days prior to therapy initiation (panel A) and 30 days (panel B), 90 days (panel C), and 3 years (panel D) after therapy initiation for 12 968 patients with human immunodeficiency virus infection in care at 1 of 8 Centers for AIDS Research Network of Integrated Clinical Systems sites across the United States from 2000 to 2012. For an animated version of this figure, please see the supplementary video.

Figure 2.

Cumulative incidence of mortality for 12 968 patients who entered care between 1 January 1998 and 31 December 2012 at 8 US clinical sites and were followed for death up to 5 years.

Figure 3.

Joint distribution of the last observed CD4 cell count and viral load for 906 patients with human immunodeficiency virus infection who died within 5 years of therapy initiation while in care at 1 of 8 Centers for AIDS Research Network of Integrated Clinical Systems sites across the United States from 2000 to 2012.