CD4 Count Recovery After Initiation of Antiretroviral Therapy in Patients Infected With Human Immunodeficiency Virus

Abstract

Background: Prognosis for patients infected with human immunodeficiency virus (HIV) correlates with levels of CD4+ T cells. Initiation of antiretroviral therapy (ART) interrupts multiple points in the virus life cycle, causing an increase in CD4 cells. The rate at which the CD4 count recovers is highly variable and subject to influence by many factors.

Methods: We performed a deidentified data review to determine factors influencing the rate of CD4 count recovery after ART initiation. The associations between the changes in CD4 count from baseline at 5 time points, and factors including age, race, weight, baseline CD4 count, baseline viral load, specific ART medications and various comorbidities, were evaluated with univariate and multivariate analyses, using t-test, analysis of variance and multiple regressions.

Results: CD4 count continued to rise even up to 10 years after ART initiation, with the steepest increase in the first 3 months. High baseline viral load and low baseline CD4 count had the most consistent positive influence on CD4 count recovery rate across the 5 measured time points. Other factors that were significantly positively associated with CD4 recovery rate included younger baseline age, higher baseline weight and female gender.

Conclusions: CD4 counts in HIV positive patients who consistently take ART continue to increase out to at least 10 years. Patients with a more advanced HIV infection at baseline, as indicated by high viral loads or low CD4 counts, have a greater rate of CD4 count recovery after starting ART, possibly because their CD4 counts have more room for improvement.

Keywords: CD4 count; Human immunodeficiency virus; Recovery.