Long-term evolution of CD4+ cell count in patients under combined antiretroviral therapy

被引：19

作者：

Pantazis, Nikos ^{[1
]}

Papastamopoulos, Vasilios ^{[2
]}

Paparizos, Vasilios ^{[3
]}

Metallidis, Simeon ^{[4
]}

Adamis, Georgios ^{[5
,6
]}

Antoniadou, Anastasia ^{[7
]}

Psichogiou, Mina ^{[8
]}

Chidi, Maria ^{[9
]}

Sambatakou, Helen ^{[10
]}

Sipsas, Nikolaos, V ^{[11
,12
]}

Gogos, Charalambos ^{[13
]}

Chrysos, Georgios ^{[14
]}

Panagopoulos, Periklis ^{[15
]}

Katsarou, Olga ^{[12
,16
]}

Gikas, Achilleas ^{[17
]}

Touloumi, Giota ^{[1
]}

Adamis, G. ^{[21
]}

Antoniadou, A. ^{[18
]}

Chini, M. ^{[26
]}

Chrysos, G. ^{[19
]}

Gikas, A. ^{[17
]}

Gogos, H. A. ^{[22
]}

Katsarou, O. ^{[23
,24
]}

Lazanas, M.

Metallidis, S. ^{[27
]}

Panagopoulos, P. ^{[31
]}

Paparizos, V ^{[28
]}

Papastamopoulos, V ^{[30
]}

Paraskevis, D.

Psychogiou, M. ^{[20
]}

Sambatakou, H. ^{[29
]}

Sipsas, N., V ^{[12
,25
]}

Touloumi, G. ^{[1
]}

Pantazis, N. ^{[1
]}

Vourli, G. ^{[1
]}

Nitsotolis, T. ^{[19
]}

Xylomenos, G. ^{[21
]}

Marangos, M. N. ^{[22
]}

Kouramba, A. ^{[23
,24
]}

Kontos, A. ^{[12
,25
]}

Lioni, A. ^{[26
]}

Tsachouridou, O. ^{[27
]}

Kourkounti, S. ^{[28
]}

Ganitis, A. ^{[31
]}

Barbounakis, E. ^{[17
]}

Gogos, H.

机构：

[1] Univ Athens, Dept Hyg Epidemiol & Med Stat, Med Sch, 75 Mikras Asias, Athens 11527, Greece

[2] Evangelismos Gen Hosp Athens, Div Infect Dis, Dept Internal Med 5, Athens, Greece

[3] Univ Athens, AIDS Unit, Clin Venereol & Dermatol Dis, Med Sch,Syngros Hosp, Athens, Greece

[4] Aristotle Univ Thessaloniki, AHEPA Univ Hosp, Infect Dis Unit, Internal Med Dept 1, Thessaloniki, Greece

[5] Gen Hosp Athens G Gennimatas, Dept Internal Med 1, Athens, Greece

[6] Gen Hosp Athens G Gennimatas, Infect Dis Unit, Athens, Greece

[7] Univ Athens, Dept Internal Med 4, Med Sch, Attikon Univ Gen Hosp, Athens, Greece

[8] Univ Athens, Dept Internal Med 1, Med Sch, Athens, Greece

[9] Red Cross Gen Hosp, Dept Internal Med 3, Infect Dis Unit, Athens, Greece

[10] Univ Athens, Dept Internal Med 2, Hippokrat Univ Gen Hosp, HIV Unit,Med Sch, Athens, Greece

[11] Laikon Athens Gen Hosp, Infect Dis Unit, Dept Pathophysiol, Athens, Greece

[12] Univ Athens, Med Sch, Athens, Greece

[13] Univ Patras, Gen Hosp, Dept Internal Med & Infect Dis, Patras, Greece

[14] Tzane Gen Hosp Piraeus, Infect Dis Unit, Athens, Greece

[15] Democritus Univ Thrace, Infect Dis Unit, Univ Dept Internal Med 2, Univ Hosp Alexandroupolis, Alexandroupolis, Greece

[16] Univ Athens, Natl Reference Ctr Congenital Bleeding Disorders, Laikon Athens Gen Hosp, Blood Ctr, Athens, Greece

[17] Univ Hosp Heraklion, Dept Internal Med, Iraklion, Crete, Greece

[18] Univ Athens, Dept Internal Med 4, Med Sch, Attikon Univ Hosp, Athens, Greece

[19] Tzaneio Gen Hosp Piraeus, Infect Dis Unit, Piraeus, Greece

[20] Univ Athens, Dept Propedeut Med 1, Med Sch, Laikon Gen Hosp, Athens, Greece

[21] G Gennimatas Athens Gen Hosp, Dept Med 1, Infect Dis Unit, Athens, Greece

[22] Patras Univ Hosp, Dept Internal Med 1, Infect Dis Sect, Patras, Greece

[23] Laikon Gen Hosp, Blood Transfus Unit, Athens, Greece

[24] Laikon Gen Hosp, Natl Reference Ctr Congenital Bleeding Disorders, Athens, Greece

[25] Univ Athens, Gen Hosp Athens Laikon, Infect Dis Unit, Dept Pathophysiol, Athens, Greece

[26] Red Cross Gen Hosp Athens, Infect Dis Unit, Athens, Greece

[27] Aristotle Univ Thessaloniki, Internal Med Dept 1, Infect Dis Div, Med Sch, Thessaloniki, Greece

[28] Univ Athens, Clin Venereol & Dermatol Dis, Med Sch, AIDS Unit,Syngros Hosp, Athens, Greece

[29] Univ Athens, Hippokrat Gen Hosp, Dept Internal 2, HIV Unit,Med Sch, Athens, Greece

[30] Evaggelismos Athens Gen Hosp, Dept Internal Med, Infect Dis & HIV Div, Athens, Greece

[31] Democritus Univ Thrace, Infect Dis Unit, Univ Gen Hosp Alexandroupolis, Alexandroupolis, Greece

来源：

AIDS | 2019年 / 33卷 / 10期

关键词：

antiretroviral therapy; CD4(+) lymphocyte count; HIV infections; viremia; HUMAN-IMMUNODEFICIENCY-VIRUS; CUMULATIVE HIV VIREMIA; BASE-LINE; IMMUNOLOGICAL RECOVERY; INFECTED PATIENTS; VIRAL LOAD; AIDS; SUPPRESSION; RISK; RESTORATION;

D O I：

10.1097/QAD.0000000000002248

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Objective: Combined antiretroviral treatment (cART) results in profound immunologic improvement, but it is unclear whether CD4(+) cell counts return to levels similar to those of HIV-negative individuals. We explore long-term CD4(+) cell count evolution post-cART and its association with baseline levels, virologic suppression, pre-cART cumulative viremia and other factors. Design: Data were derived from the AMACS. Included individuals were adults who started cART, at least 2003, while previously ART-naive. Methods: Changes in CD4(+) cell counts were modeled through piecewise linear mixed models. Results: A total of 3405 individuals were included. The majority was male (86.0%), homosexual (58.8%) with median (IQR) age at cART initiation 36 (31-44) years and a median (IQR) follow-up of 3.9 (2.0-6.9) years. Most persons (57%) starting cART with less than 200 cells/mu l did not reach 600 cells/mu l after 7 years of treatment. Those starting cART with 200-349 CD4(+) cells/mu l could reach 600 cells/mu l within less than 2 years of fully suppressive treatment. Probability of CD4(+) normalization (i.e. > 800 cells/mu l) after 7 years of suppressive treatment was 24 and 46% for those starting treatment with less than 200 or 200-349 CD4(+) cells/mu l, respectively. Lower pre-cART cumulative viremia was associated with faster CD4(+) recovery. CD4(+) cell count increases after 4 years were either insignificant or very slow, irrespectively of baseline levels. Conclusion: cART initiation before CD4(+) cell count drops below 350 cells/mu l is crucial for achieving normal CD4(+) levels. These findings underline the importance of timely diagnosis and cART initiation as the risk of both AIDS and non-AIDS-related morbidity/mortality remains increased in patients with incomplete CD4(+) recovery. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.

引用

页码：1645 / 1655

页数：11

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