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Abstract
Changes in CD4 cell count out to six years in persons with sustained virologic suppression. Implications for when to start ARV therapy?
R. Moore, J. Keruly
Background: It is unclear whether the CD4 improves to normal levels, or reaches a less-than-normal plateau with sustained suppression of HIV-RNA by HAART.
Methods: We analyzed data from all patients of the Johns Hopkins HIV Clinical Cohort in Baltimore, MD, who
(1) were followed for >1 year on HAART, and
(2) had sustained HIV-RNA suppression to <400 copies/ml on HAART. We analyzed annual change in CD4 and development of a new AIDS-defining illness (ADI) for 6 years from start of HAART, stratified by baseline CD4 as <200, 201-350, >350cells/uL.
Results: 280 patients were followed for a mean 1430 days (range: 366-3500). Median age = 40 years, with 69% male, 66% black, 29% IDU risk, and mean baseline CD4 of 229 (IQR 60,338). By 6 years, median CD4 was 411 in those with baseline CD4 < 200, 514 for baseline CD4 201-350, and 614 for baseline CD4 > 350 (Fig 1). CD4 plateaus occurred for each CD4 stratum, with only CD4 >350 patients returning to ‘normal‘.The probability of an ADI was 13%, 12% and 1.5% of patients with CD4 <200, 201-35, >350 respectively (P< 0.02 between CD4<200-350, and >350). In addition to baseline CD4, younger age was associated with higher CD4 response, but not sex, race, HIV risk group or ARV (NNRTI vs PI).
[Figure 1]
Conclusions: Only patients with baseline CD4 > 350 returned to near normal CD4. These data suggest that waiting to start HAART at lower CD4 levels will result in the CD4 not returning to normal levels and the clinical event rate is higher. This may have implications for when to start therapy.
AIDS 2006 - XVI International AIDS Conference
Abstract no.
THPE0109
Suggested Citation
"R.Moore, et al.
Changes in CD4 cell count out to six years in persons with sustained virologic suppression. Implications for when to start ARV therapy?.
:
AIDS 2006 - XVI International AIDS Conference:
Abstract no.
THPE0109"
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