Korean J Intern Med.  2015 Sep;30(5):705-713. 10.3904/kjim.2015.30.5.705.

The CD4 slope can be a predictor of immunologic recovery in advanced HIV patients: a case-control study

• Kim KH
• Yi J
• Lee SH

• KMID: 2381569
• DOI: http://doi.org/10.3904/kjim.2015.30.5.705

Abstract

BACKGROUND/AIMS
Advanced human immunodeficiency virus (HIV) infection, despite sustained viral suppression by highly active antiretroviral therapy (HAART), is a risk factor for poor immunologic recovery. However, some patients with advanced infection do show immunologic recovery. In this study, predictive factors of immunologic recovery were analyzed in advanced HIV patients showing sustained viral suppression.
METHODS
A case-control study was conducted in HIV-infected adult patients with HIV-1 RNA < 50 copies/mL maintained for 4 years or longer and who were receiving HAART. Advanced HIV infection was defined as a baseline CD4 T cell count < 200/mm3. Immunologic responders were defined as patients showing immunologic recovery (CD4 T cell counts > or = 500/mm3 at 4 years with HAART). To analyze the CD4 T cell kinetics, the CD4 slope (monthly changes in the CD4 T cell count) was estimated for each patient using a linear regression between the CD4 T cell count and the time since HAART initiation.
RESULTS
Of 102 eligible patients, 73 had advanced HIV, and 33 (45.2%) showed immunologic recovery. The median CD4 slopes (cells/mm3 per month) during 0 to 6 and 0 to 12 months of HAART in the 73 advanced patients were significantly higher in responders than in non-responders (0 to 6 months, 38.6 vs. 22.8; 0 to 12 months, 24.5 vs. 13.5). Multivariate analyses showed opportunistic infections at the start of HAART (adjusted odds ratio [OR], 0.28) and a CD4 slope > or = 20 during 0 to 12 months of HAART (adjusted OR, 10.10) were independently associated with immunologic recovery.
CONCLUSIONS
The CD4 slope can be an early predictor of long-term immunologic recovery in advanced HIV patients.

Keyword

Antiretroviral therapy; CD4 T lymphocyte; Immunologic response

MeSH Terms

Adult
Anti-HIV Agents/therapeutic use
Antiretroviral Therapy, Highly Active
Biomarkers/blood
*CD4 Lymphocyte Count
Case-Control Studies
Chi-Square Distribution
Female
HIV Infections/*diagnosis/drug therapy/*immunology/virology
HIV-1/drug effects/genetics/*immunology
Humans
Linear Models
Logistic Models
Male
Middle Aged
Monitoring, Immunologic/*methods
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
RNA, Viral/blood
Time Factors
Treatment Outcome
Viral Load
Anti-HIV Agents
Biomarkers
RNA, Viral