In:
JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 81, No. 1 ( 2019-05-1), p. 10-17
Abstract:
Low CD4 + recovery among HIV-positive individuals who achieve virologic suppression is common but has not been studied among individuals initiating treatment at CD4 + counts of 〉 500 cells/mm 3 . Setting: United States, Africa, Asia, Europe and Israel, Australia, Latin America. Methods: Among participants randomized to immediate antiretroviral therapy (ART) in the Strategic Timing of AntiRetroviral Therapy trial, low CD4 + recovery was defined as a CD4 + increase of 〈 50 cells/mm 3 from baseline after 8 months despite viral load of ≤200 copies/mL. Risk factors for low recovery were investigated with logistic regression. Results: Low CD4 + recovery was observed in 39.7% of participants. Male sex [odds ratio (OR), 1.53; P = 0.007], lower screening CD4 + cell counts (OR, 1.09 per 100 fewer cells/mm 3 ; P = 0.004), higher baseline CD8 + cell counts (OR, 1.05 per 100 more cells/mm 3 ; P 〈 0.001), and lower HIV RNA levels (OR, 1.93 per log 10 decrease; P 〈 0.001) were associated with low CD4 + recovery. D-dimer had a quadratic association with low CD4 + recovery, with lowest odds occurring at 0.32 μg/mL. At lower HIV RNA levels, the odds of low CD4 + recovery were elevated across the levels of screening CD4 + count; but at higher HIV RNA levels, the odds of low CD4 + recovery were higher among those with lower vs. higher screening CD4 + . Conclusions: Low CD4 + recovery is frequent among participants starting ART at high CD4 + counts. Risk factors include male sex, lower screening CD4 + cell counts, higher CD8 + cell counts, and lower HIV RNA levels. More follow-up is required to determine the impact of low CD4 + recovery on clinical outcomes.
Type of Medium:
Online Resource
ISSN:
1525-4135
DOI:
10.1097/QAI.0000000000001967
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
2038673-4
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