3:45 LB8.
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CD4 T-Lymphocyte Recovery in Individuals with Advanced HIV-1 Infection Receiving Potent Antiretroviral Therapy for 4 Years: The Swiss HIV Cohort Study
G. Kaufmann*1, L. Perrin2, G. Pantaleo3, M. Opravil4, H. Furrer6 , A. Telenti3, B. Hirschel2, B. Ledergerber4, P. Vernazza7, E. Bernasconi8, M. Rickenbach3, M. Egger10, and M. Battegay1
1Basel Ctr. for HIV Res., Switzerland; 2Univ. Hosp. Geneva, Switzerland; 3 CHUV, Lausanne, Switzerland; 4Univ. Hosp. Zurich, Switzerland; 5Univ. Hosp. Berne, Switzerland; 7Cantonal Hosp. St.Gallen, Switzerland; 8Regional Hosp. Lugano, Switzerland; and 9Med. Res. Council Hlth. Services Res. Collaboration, Bristol, UK
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Background: Highly active antiretroviral therapy (HAART) for HIV-1 infection allows a recovery of CD4 T lymphocytes, reducing the risk of opportunistic infections. Few studies have explored the long-term T-cell responses to HAART.
Methods: HIV-1 RNA levels and T-cell counts were analyzed over 4 years in 2235 participants of the Swiss HIV Cohort Study, commencing HAART in 1996/1997, and in subgroups without (CONT; n = 985) or with treatment interruptions (DISCONT; n = 1250). CD4 increases, the proportions with >500 and <200 CD4 T lymphocytes/muL and determinants of CD4 recovery were evaluated.
Results: At 4 years, 64.8% (82% CONT vs 50% DISCONT; p <0.001) suppressed HIV-1 RNA to <400 HIV-1 RNA copies/mL. Median CD4 counts increased from 190 to 357 cells/muL (421 CONT vs 307 cells//muL DISCONT; p <0.001), while a trend towards declining annual CD4 changes was observed. At 4 years, 36% (47% CONT vs 24% DISCONT; p <0.001) reached >500 CD4 cells/muL, but CD4 count remained <200 cells/muL in 21% (6% CONT vs 29% DISCONT; p <0.001). Larger CD4 increases were associated with higher baseline HIV-1 RNA, a larger proportion of undetectable HIV-1 RNA levels, lower baseline CD8 count, younger age, and no antiretroviral pretreatment, whereas higher baseline HIV-1 RNA, sustained virological control, higher nadir, and baseline CD4 count as well as female gender predicted >500 CD4 cells/muL at 4 years.
Conclusion: At 4 years, only 36% of patients receiving HAART reached >500cells/L and 21% remained <200 CD4 cells/muL. Treatment interruptions, poor virological control, and low baseline CD4 counts negatively affected the CD4 recovery.
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