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Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4+ T-cell recovery once HIV-1 suppression is achieved?

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Jarrin Inma, Pantazis Nikos, Dalmau Judith, Phillips Andrew N, Olson Ashley, Mussini Cristina, Boufassa Faroudy, Costagliola Dominique, Porter Kholoud, Blanco Juliá, Del Amo Julia, Martinez-Picado Javier,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal AIDS (London, England)
Volume (Issue) 29(17)
Page(s) 2323 - 33
Title of proceedings AIDS (London, England)
DOI 10.1097/qad.0000000000000805

Open Access

URL http://doi.org/10.1097/QAD.0000000000000805
Type of Open Access Publisher (Gold Open Access)

Abstract

This article compares trends in CD4 T-cell recovery and proportions achieving optimal restoration (≥500 cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors. We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4 less than 200 cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration. Of 4024 individuals, 294 (7.3%) were classified as rapid progressors. At the same CD4 T-cell count at cART start (baseline), rapid progressors experienced faster CD4 T-cell increases than nonrapid progressors in first month [difference (95% confidence interval) in mean increase/month (square root scale): 1.82 (1.61; 2.04)], which reversed to slightly slower increases in months 1-18 [-0.05 (-0.06; -0.03)] and no significant differences in 18-60 months [-0.003 (-0.01; 0.01)]. Percentage achieving optimal restoration was significantly lower for rapid progressors than nonrapid progressors at months 12 (29.2 vs. 62.5%) and 36 (47.1 vs. 72.4%) but not at month 60 (70.4 vs. 71.8%). These differences disappeared after adjusting for baseline CD4 T-cell count: odds ratio (95% confidence interval) 0.86 (0.61; 1.20), 0.90 (0.38; 2.17) and 1.56 (0.55; 4.46) at months 12, 36 and 60, respectively. Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4 T-cell counts than nonrapid progressors, but are less likely to achieve optimal restoration during the first 36 months after cART, mainly because of lower CD4 T-cell counts at cART initiation.
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