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Factors associated with long‐term CD 4 cell recovery in HIV ‐infected patients on successful antiretroviral therapy
Author(s) -
Collazos J,
ValleGaray E,
Carton JA,
Montes AH,
SuarezZarracina T,
De la Fuente B,
Asensi V
Publication year - 2016
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12354
Subject(s) - medicine , interquartile range , viral load , regimen , gastroenterology , univariate analysis , hepatitis c , nadir , multivariate analysis , immunology , human immunodeficiency virus (hiv) , satellite , engineering , aerospace engineering
Objectives The aim of the study was to study the factors associated with immunological recovery in HIV ‐infected patients with suppressed viral load. Methods Nadir and current CD 4 cell counts were recorded in 821 patients, as well as many demographic, epidemiological, lifestyle, clinical, therapeutic, genetic, laboratory, liver fibrosis and viral hepatitis parameters. Results The median age of the patients was 44.4 years [interquartile range ( IQR ) 40.3–48.0 years], the median time since HIV diagnosis was 15.3 years ( IQR 10.5–18.9 years), the median time of suppressed viral load was 7.0 years ( IQR 4.0–10.0 years) and the median time on the current antiretroviral regimen was 2.8 years ( IQR 1.4–4.7 years). The median nadir and current CD 4 counts were 193.0 ( IQR 84.0–301.0) and 522.0 ( IQR 361.0–760) cells/μL, respectively, separated by a median period of 10.2 years ( IQR 5.9–12.9 years). The median CD 4 count gain during follow‐up was 317.0 ( IQR 173.0–508.0) cells/μL. Many variables were associated with CD 4 cell gains in univariate analyses, including age, gender, epidemiology, prior clinical conditions, fibrosis stage, transient elastometry, aspartate aminotransferase ( AST ), nadir CD 4 count and hepatitis B and C virus infections and genotypes, as well as the durations of follow‐up since nadir CD 4 count, overall antiretroviral treatment, current antiretroviral regimen, protease inhibitor therapy and suppression of viral load. Multivariate analysis revealed that longer duration of HIV suppression ( P < 0.0001), more advanced clinical Centers for Disease Control and Prevention ( CDC ) stages ( P < 0.0001), younger age ( P = 0.0003), hepatitis C virus genotypes 1 and 4 ( P = 0.003), sexual acquisition of HIV ( P = 0.004), and lower transient elastometry values ( P = 0.03) were independent predictors of CD 4 cell gains. Overall, the model accounted for 14.2% of the variability in CD 4 count. Conclusions In addition to the duration of HIV suppression, HIV ‐related diseases, HIV epidemiology, age, hepatitis C virus genotypes, and liver fibrosis were independently associated with long‐term immunological recovery.