|
|
|
|
|
Session 103
Poster Abstracts Antiretroviral Therapy: Long-Term Immunologic Outcomes Thursday, 1:30 - 3:30 pm Hall A |
Background: After 3 to 4
years of potent antiretroviral therapy (HAART), CD4 T-lymphocyte count appears
to plateau. To verify this preliminary observation, we have analyzed CD4 T-cell
recovery over 7 years in the Swiss HIV Cohort Study (SHCS).
Methods: All SHCS
patients were included who commenced HAART (> 2 antiretroviral drugs: n = 6509;
mean age 38 ± 10 years, 70% male). Plasma HIV-1 RNA, CD4, and CD8 T-lymphocyte
data were evaluated at annual intervals. The primary endpoint was the absolute
change in CD4 T-cell count. T-cell kinetics were analyzed in patients receiving
continuous HAART (CONT; n = 2677), switching to non-HAART regimens (non-HAART;
n = 613), and in patients with intermittent treatment interruptions (IR; n = 3219).
CD4 increases were compared in these groups using analysis of variance models,
adjusted for demographic and HIV-1 specific baseline variables.
Results: In the entire
cohort, CD4 T-cell count increased from 133 at baseline (interquartile range:
58 to 265) to 435 cells/mL (286 to 643; n = 3868) at 4 years, but subsequently declined to 409
cells/mL (268 to 581; n = 1156)
at 7 years. Mean plasma HIV-1 RNA was < 50 in 49.1%, 50 to 400 copies/mL in
22.1%, 400 to 1000 copies in 7.1%, and > 1000 copies/mL in 21.7% of
patients. In the CONT, non-HAART, and IR groups, baseline CD4 count was 193 (82
to 316), 152 (65 to 269), and 238 cells/mL (102 to 392), respectively (p < 0.001), whereas baseline plasma HIV-1 RNA was 4.8 (4.0 to 5.3),
4.8 (3.9 to 5.2), and 4.7 (4.0 to 5.2) log10 copies/mL (p = 0.024). The median age was 37, 35,
and 38 years, respectively; p < 0.001).
CD4 count increased in the CONT, non-HAART, and IR groups by 297 (176 to 430),
219 (94 to 348), and 152 (13 to 315) cells/mL, respectively, in the first 4 years (p < 0.001), and by 52 (–36 to 128),
43 (–49 to 130), and 0.5 (–143 to 119) cells/mL from year 4 to 7 (p < 0.001).
Conclusions: CD4 T-cell
recovery occurs predominantly in the first 4 years of antiretroviral therapy
and shows further, but small increases from year 4 to 7 in continuously treated
patients.
Keywords: CD4 ; Recovery; HAART
 |