Long-term trends in CD4 cell counts and impact of viral failure in individuals starting antiretroviral therapy: UK Collaborative HIV Cohort (CHIC) study

R. A. Hughes, J. A. C. Sterne, J. Walsh, L. Bansi, R. Gilson, C. Orkin, T. Hill, J. Ainsworth, J. Anderson, M. Gompels, D. Dunn, M. A. Johnson, A. N. Phillips, D. Pillay, C. Leen, P. Easterbrook, B. Gazzard, M. Fisher, C. A. Sabin

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Objective
The aim of the study was to describe trends in CD4 cell counts in HIV-infected patients after initiation of combination antiretroviral therapy (cART), according to CD4 cell count at initiation (baseline), and to quantify the implications of virological failure for these trends.

Methods
Eligible participants from the UK Collaborative HIV Cohort (CHIC) were antiretroviral-naive and started cART after 1997. Random effects were used to model CD4 cell count trends, accounting for multiple measurements within participants. We assessed whether CD4 cell count trends varied according to baseline CD4 cell count and separately in participants with and without post-cART virological failure. Effects of post-cART virological failure (41000 HIV-1 RNA copies/mL) on subsequent CD4 cell counts were evaluated.

Findings
A total of 7069 participants were included in the analysis (median follow-up in all baseline CD4 cell count groups was >= 35 months). Among participants without virological failure >= 6 months after the start of cART, CD4 cell counts continued to increase up to 8 years, with little evidence that differences between baseline CD4 cell count groups diminished over time. Virological failure >= 6 months after the start of cART was associated with lower subsequent CD4 cell counts, with greater CD4 cell count reduction for more recent virological failure and higher viral load.

Conclusions
Post-cART CD4 cell counts are strongly related to pre-cART CD4 cell counts. CD4 cell count recovery is greatest in individuals who can avoid viral loads > 1000 copies/mL while on cART.

Original languageEnglish
Pages (from-to)583-593
Number of pages11
JournalHIV Medicine
Volume12
Issue number10
DOIs
Publication statusPublished - Nov 2011

Keywords / Materials (for Non-textual outputs)

  • CD4 cell count
  • combination antiretroviral therapy
  • HIV-1

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