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Original article

Predicting the magnitude of short-term CD4+ T-cell recovery in HIV-infected patients during first-line highly active antiretroviral therapy

Antonella Castagna, Laura Galli, Carlo Torti, Antonella D’Arminio Monforte, Cristina Mussini, Andrea Antinori, Alessandro Cozzi-Lepri, Nicoletta Ladisa, Andrea De Luca, Elena Seminari, Nicola Gianotti, Adriano Lazzarin

Corresponding author name: Nicola Gianotti
Corresponding author e-mail: nicola.gianotti@hsr.it

Citation: Antiviral Therapy 2010; 15:165-175
doi: 10.3851/IMP1513

Date accepted: 26 September 2009
Date published online: 01 April 2010

Abstract

Background: The extent of short-term CD4+ T-cell recovery in patients tolerating first-line highly active antiretroviral therapy (HAART) and attaining undetectable HIV RNA levels is inadequately defined.

Methods: We retrospectively analysed patients in four Italian cohorts who started HAART between January 1996 and September 2006. All patients had known HCV coinfection status, did not modify the regimen for 6 months and had <50 HIV RNA copies/ml at the end of the sixth month.

Results: The analysis involved 1,488 patients (1,096 males, 73.7%) with a median age of 43 years (interquartile range [IQR] 39–49); 435 (29.2%) were positive for HCV, 71 (4.8%) were positive for hepatitis B surface antigen (HBsAg) and 76 (5.1%) had experienced a previous AIDS-defining event. At baseline, patient CD4+ T-cell counts were 226 cells/µl (IQR 99–332), CD4+ T-cell percentages were 14.7% (IQR 8.7–21.2) and HIV RNA levels were 4.91 log10 copies/ml (IQR 4.38–5.34). Overall, 24-week CD4+ T-cell recovery was 144 cells/µl (IQR 70–240). At multivariable analysis, T-cell recovery was positively related to the use of a boosted protease inhibitor (P<0.0001) or thymidine analogues (P<0.0001), baseline HIV RNA levels (P<0.0001), the baseline percentage of CD4+ T-cells (P<0.0001) and the absence of HCV coinfection (P=0.006). Age, gender, baseline CD4+/CD8+ T-cell ratio and a history of AIDS-defining events had no independent effect on CD4+ T-cell recovery.

Conclusions: Among HIV-infected patients tolerating first-line HAART and with undetectable HIV RNA after 6 months, CD4+ T-cell recovery is significantly greater in those without HCV coinfection, with a high baseline viral load, a high baseline percentage of CD4+ T-cells and in those treated with a boosted protease inhibitor.

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