Abstract

An increasing number of HIV-positive individuals now start antiretroviral therapy (ART) with high CD4 cell counts. We investigated whether this makes restoration of CD4 and CD8 cell counts and the CD4:CD8 ratio during virologically suppressive ART to median levels seen in HIV-uninfected individuals more likely and whether restoration depends on gender, age, and other individual characteristics. We determined median and quartile reference values for CD4 and CD8 cell counts and their ratio using cross-sectional data from 2309 HIV-negative individuals. We used longitudinal measurements of 60,997 HIV-positive individuals from the Antiretroviral Therapy Cohort Collaboration in linear mixed-effects models. When baseline CD4 cell counts were higher, higher long-term CD4 cell counts and CD4:CD8 ratios were reached. Highest long-term CD4 cell counts were observed in middle-aged individuals. During the first 2 years, median CD8 cell counts converged toward median reference values. However, changes were small thereafter and long-term CD8 cell count levels were higher than median reference values. Median 8-year CD8 cell counts were higher when ART was started with <250 CD4 cells/mm. Median CD4:CD8 trajectories did not reach median reference values, even when ART was started at 500 cells/mm. Starting ART with a CD4 cell count of ≥500 cells/mm makes reaching median reference CD4 cell counts more likely. However, median CD4:CD8 ratio trajectories remained below the median levels of HIV-negative individuals because of persisting high CD8 cell counts. To what extent these subnormal immunological responses affect specific clinical endpoints requires further investigation.

Highlights

  • Since 2012, US Guidelines have recommended offering antiretroviral therapy (ART) to all individuals diagnosed with HIV, regardless of their CD4 cell count.[1]

  • We studied whether an early start, at high CD4 cell counts followed by long-term virologically suppressive ART, J Acquir Immune Defic Syndr Volume 80, Number 3, March 1, 2019

  • HIV-Negative Population Median CD4 and CD8 cell count in HIV-negative participants decreased with older age, whereas the median CD4:CD8 ratio was higher with older age

Read more

Summary

Introduction

Since 2012, US Guidelines have recommended offering antiretroviral therapy (ART) to all individuals diagnosed with HIV, regardless of their CD4 cell count.[1] As a result, an increasing number of HIV-1–positive individuals start ART at high CD4 cell counts. Of those starting ART, a considerable proportion does so at a relatively old age. We investigated whether this makes restoration of CD4 and CD8 cell counts and the CD4:CD8 ratio during virologically suppressive ART to median levels seen in HIV-uninfected individuals more likely and whether restoration depends on gender, age, and other individual characteristics

Objectives
Methods
Results
Discussion
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call