Patients Characteristics and Clinical Implications of Suboptimal CD4 T-Cell Gains After 1 Year of Successful Antiretroviral Therapy

Felix      Gutierrez; Sergio      Padilla; Mar      Masia; Jose   A.   Iribarren; Santiago      Moreno; Pompeyo      Viciana; Jose      Hernandez-Quero; Remedios      Aleman; Francesc      Vidal; Miguel      Salavert; Jose   R.   Blanco; Manuel      Leal; Fernando      Dronda; Santiago   Perez   Hoyos; Julia   del   Amo; CORIS-MD (see appendix)

Abstract

To describe characteristics and prognosis of patients with suboptimal immunological response to combined antiretroviral therapy (CART). Using data from a multicenter cohort study, we selected patients who initiated CART and showed suboptimal CD4-T cell response (defined as < 50 cells/L increase) after 1 year of therapy, despite sustained virological suppression. Characteristics of those patients were compared with subjects who showed optimal immunological response. Of 650 patients with virological suppression, 108 (16.6%) showed suboptimal CD4-T cell response. Independent predictors of suboptimal response were previous injection drug use (OR, 1.85; 95% CI, 1.12-2.98) and age at CART initiation (OR, 1.04 per year increase; 95%CI, 1.01-1.06). Hepatitis C virus coinfection was not associated with impaired inmunological response. As compared with patients with optimal immunological response, those with suboptimal response had a higher mortality rate (3.22 versus 0.71 per 100 person-years; p=.001), but a similar rate of new AIDSdefining events. In patients with sustained virological suppression with CART, previous injection drug use, but not hepatitis C virus coinfection, and older age at initiation of therapy were associated with suboptimal CD4 T-cell responses. Patients with suboptimal response had a higher mortality over time, mainly due to diseases other than AIDS-defining events.

Keywords: HIV, AIDS, discordant responses, treatment outcome, immunological response, CD4 response