Predictors of CD4 cell recovery following initiation of antiretroviral therapy among HIV-1 positive patients with well-estimated dates of seroconversion. HIV Medicine
Stirrup et al. on behalf of CASCADE Collaboration in EuroCoord aimed to investigate factors that predict speed of recovery and long-term CD4 cell count in HIV-1 seroconverters initiating combination antiretroviral therapy (cART), and to quantify the influence of very early treatment initiation. They used data from the CASCADE multinational cohort collaboration of HIV-1 seroconverters and analysed pre- and post-treatment data of patients with seroconversion dates estimated January 2003 – March 2014 (n=7600).
The authors found that “true’ CD4 count at cART initiation was the strongest predictor of CD4 count beyond 3 years on cART. CD4 recovery was more rapid for patients in whom treatment was initiated within 4 months. For a given CD4 count, higher viral load (VL) at initiation was strongly associated with higher post-treatment CD4 recovery. Use of an integrase-inhibitor regimen at treatment initiation was found to be associated with a moderate improvement in post-treatment recovery in CD4 relative to the NNRTI regimen.
In conclusion, CD4 count at cART initiation is the most important factor in predicting post-treatment recovery, but VL provides substantial additional information. If cART is initiated in the first 4 months following seroconversion, recovery of CD4 counts appears to be more rapid. The finding that higher plasma VL at treatment initiation predicts more rapid CD4 cell recovers is maybe explained by some evidenced that higher VL levels are associated with sequestration of CD4 cells in lymphoid tissue and that this is associated with a more rapid initial increase in circulating CD4 cells following the initiation of cART.