Objective: This article compares trends in CD4 + T-cell recovery and proportions achieving optimal restoration (≥500cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors. Methods: We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4 + less than 200cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration. Results: 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. Conclusion: 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.
Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4 + T-cell recovery once HIV-1 suppression is achieved? / Jarrin, I.; Pantazis, N.; Dalmau, J.; Phillips, A. N.; Olson, A.; Mussini, C.; Boufassa, F.; Costagliola, D.; Porter, K.; Blanco, J.; Del Amo, J.; Martinez-Picado, J.; Chene, G.; Sabin, C.; Walker, S.; Fisher, M.; Kelleher, T.; Cooper, D.; Finlayson, R.; Bloch, M.; Ramacciotti, T.; Gelgor, L.; Smith, D.; Zangerle, R.; Gill, J.; Lutsar, I.; Dabis, F.; Thiebaut, R.; Guiguet, M.; Vanhems, P.; Chaix, M. -L.; Ghosn, J.; Meyer, L.; Hamouda, O.; Kucherer, C.; Bartmeyer, B.; Antoniadou, A.; Chrysos, G.; Daikos, G. L.; Touloumi, G.; Katsarou, O.; Rezza, G.; Dorrucci, M.; Monforte, A. D.; De Luca, A.; Prins, M.; Geskus, R.; Van Der Helm, J.; Schuitemaker, H.; Sannes, M.; Brubakk, O.; Kran, A. -M. B.; Rosinska, M.; Muga, R.; Tor, J.; De Olalla, P. G.; Cayla, J.; Moreno, S.; Monge, S.; Del Romero, J.; Perez-Hoyos, S.; Sonnerborg, A.; Bucher, H. C.; Gunthard, H.; Rickenbach, M.; Malyuta, R.; Murphy, G.; Johnson, A.; Babiker, A.; Pillay, D.; Morrison, C.; Salata, R.; Mugerwa, R.; Chipato, T.; Amornkul, P. N.; Gilmour, J.; Kamali, A.; Karita, E.; Burns, F.; Giaquinto, C.; Grarup, J.; Kirk, O.; Bailey, H.; Anne, A. V.; Panteleev, A.; Thorne, C.; Aboulker, J. -P.; Albert, J.; Asandi, S.; De Wit, S.; Reiss, P.; Gatell, J.; Karpov, I.; Ledergerber, B.; Lundgren, J.; Moller, C.; Rakhmanova, A.; Rockstroh, J.; Sandhu, M.; Dedes, N.; Fenton, K.; Pizzuti, D.; Vitoria, M.; Faggion, S.; Fradette, L.; Frost, R.; Cartier, A.; Raben, D.; Schwimmer, C.; Scott, M.. - In: AIDS. - ISSN 0269-9370. - 29:17(2015), pp. 2323-2333. [10.1097/QAD.0000000000000805]
Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4 + T-cell recovery once HIV-1 suppression is achieved?
Mussini C.;Scott M.
2015
Abstract
Objective: This article compares trends in CD4 + T-cell recovery and proportions achieving optimal restoration (≥500cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors. Methods: We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4 + less than 200cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration. Results: 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. Conclusion: 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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