Background: We explored the pattern of immunologic recovery and evaluated factors associated with CD₄ cell gains among virologically suppressed HIV-infected patients in western India.

Methods:  We conducted a retrospective chart review of 515 HIV-1⁺ ART-naïve patients on HAART (stavudine/zidovudine [d4T/ZDV] + lamivudine [3TC] + nevirapine/efavirenz [NVP/EFV]). A minimum of 1 follow-up CD4 count determination (FACSCount) and undetectable viral load (<400 copies/mL, Amplicor) were included in the analysis. Data about CD4 counts in individuals before and at the last follow-up with undetectable viral load were considered. Only patients with >90% adherence on a 4-day recall were included. Median CD₄ counts at each follow-up and CD₄ slopes were determined. We used multiple linear regression analysis to evaluate those risk factors such as age (<45, ≥45 years), gender, type of regimen (ZDV vs d4T), and baseline CD₄ counts (≥50, 51 to 200, ≥201) that might influence change in CD4 counts. All analyses were intention to treat.

Results:  Of the total, 76% (392) had a minimum 6 months of follow-up. Median age was 36 years and 80% (413) were male. Median pre-therapy CD4 count was 110/mm³ and 20% (98) patients had CD4 ≤50/mm³; 68% were on ZDV, and 74% were on NVP-based regimens. (The table shows median change in CD4 counts from baseline.) Among patients with pre-therapy CD4 <200/mm³ all attained CD4 >200/ mm³; 50% attained CD4 >350/mm³, and 16% achieved CD4 >500/mm³. Predictors of poor CD4 recovery were male gender (–41.5 cells) and a baseline CD4 <50/mm³ (–88.1 and –217.4 cells as compared to CD4 51 to 200 and ≥201, respectively).

Conclusions:  Pattern of immunologic recovery (very rapid initial rise followed by slower increase) and risk factors associated with poor CD4 recovery among virologically suppressed HIV-infected patients on first-line HAART in western India is similar to those documented in the developed world. However the proportion of patients with normal CD4 counts (≥500), even at 4 years, is minimal. Immunologic recovery is better if HAART is initiated before CD4 drops to <200/mm³.

* 95% CI