Baseline Predictors of CD4 T-Lymphocyte Recovery With Combination Antiretroviral Therapy

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Summary:CD4 T-cell recovery with potent antiretroviral therapy varies considerably among HIV-1-infected patients. Data from two studies that enrolled subjects at different stages of disease progression were retrospectively combined. This analysis assessed the association between patient-specific factors and three measures of CD4 T-cell recovery after the initiation of triple-drug therapy: overall changes in CD4 cell counts; changes in CD4 cell counts during the first 8 weeks (phase I); and changes in CD4 cell counts during weeks 8-24 (phase II). Higher initial HIV-1 RNA values corresponded to greater increases in overall and phase I changes in mean CD4 cell counts, particularly among subjects with less advanced disease. In the overall and phase II cases, those subjects with suppressed HIV RNA levels had consistently higher increases in mean CD4 cell counts across both baseline HIV-1 RNA levels and CD4 cell counts than did the respective unsuppressed group. Based on a multivariate model, increases in mean phase I CD4 cell counts corresponded to higher log10 baseline HIV-1 RNA levels (p = .0001) and log10 changes in HIV-1 RNA levels at week 4 (p= .03). Patients with earlier stages of disease (p =.0001) and females (p = .01) had higher increases in phase I changes. Phase II CD4 cell counts did not depend solely on baseline HIV-1 RNA levels and CD4 cell counts but on their interaction (p = .0001) as well as on achieving virologic suppression (p = .0009).

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