Three different patterns of CD4 recovery in a cohort of Chinese HIV patients following antiretroviral therapy – a five-year observational study

Abstract

To explore the heterogeneity of CD4 responses following highly active antiretroviral therapy, the patterns of CD4 recovery of HIV-1-infected Chinese patients who have been on their first antiretroviral regimen for ≥5 years were analysed. The CD4 trajectories were traced, smoothed and differentiated into three defined profiles. Half (56.3%) were 'satisfactory responders', with CD4 gain of >100 cells/μL and a peak of >350 cells/μL, plateauing before the end of Year 5. Thirty-three (24.4%) were 'continuing responders' whose CD4 rise persisted at Year 4-5. The remaining 26 (19.3%) were 'poor responders'. Presentation with AIDS before therapy was common not just among 'poor' but also paradoxically the 'continuing' responders. While a majority had responded well to antiretroviral therapy, older patients and those with AIDS diagnosis before initiation of therapy may never achieve a satisfactory level even with effective treatment. Categorization of HIV patients by their CD4 trajectory may support the prediction of immunological outcome over time, and ultimately inform treatment choices.

Immune recovery of middle-aged HIV patients following antiretroviral therapy

“…In addition to the well-known impact of age on CD4 recovery as reported in studies locally and internationally, [1,3,4] we observed that these responses varied between late and non-late treatment initiation. Middle-aged adults in late treatment initiation had faster CD4 recovery than elderly.…”

“…[1,2] Compared with younger patients, older adults had poorer CD4 recovery after highly active antiretroviral therapy (HAART) initiation, higher mortality and co-morbidity rate. [3,4] However, owing to poor retention in care in young patients, the risk of viral rebound, virological failure, and immunological failure was higher in younger than older patients. [1,5] It is clear that the final clinical outcome is dependent not just on the rate and extent of one's immunological recovery, but also on factors associated with good adherence to and tolerability of prescribed HAART regimens.…”

HIV Linkage to Care and Retention in Care Rate Among MSM in Guangzhou, China

“…Of note, previous studies have shown that younger patients have more satisfactory CD4 recovery after ART initiation than older adults. 37,38 These all suggest that interventions for enhancing retention in ART care among younger patients and those with higher CD4 levels are needed.…”

Incomplete immune reconstitution in HIV/AIDS patients on antiretroviral therapy: Challenges of immunological non-responders

“…Total CD4 + T-cell count > 350 cells/µl and/or increase in the CD4 + T-cell count > 30% from baseline at 1-10 years after ART initiation, with an undetectable plasma VL. 144,177,242,243 Total CD4 + T-cell count < 500 cells/µl and CD4/CD8 ratio < 1 at 8 years after ART initiation, with plasma HIV RNA < 50 copies/ml.…”