Long-term increase in CD4+ T-cell counts during combination antiretroviral therapy for HIV-1 infection
Year: 2010
Type: article
Abstract: OBJECTIVE: To inform guidelines concerning when to initiate combination antiretroviral therapy (ART), we investigated whether CD4(+) T-cell counts (CD4 cell counts) continue to increase over long periods of time on ART. Losses-to-follow-up and some patients discontinuing ART at higher CD4 cell counts hamper such evaluation, but novel statistical methods can help address these issues. We estimated the long-term CD4 cell count trajectory accounting for losses-to-follow-up and treatment discontinuations. DESIGN: The study population included 898 US patients first initiating ART in a randomized trial (AIDS Clinical Trials Group 384); 575 were subsequently prospectively followed in an observational study (AIDS Clinical Trials Group Longitudinal Linked Randomized Trials). METHODS: Inverse probability of censoring weighting statistical methods were used to estimate the CD4 cell count trajectory accounting for losses-to-follow-up and ART discontinuations, overall and for pretreatment CD4 cell count categories ( 500 cells/microl). RESULTS: Median CD4 cell count increased from 270 cells/microl pre-ART to an estimated 556 cells/microl at 3 and 532 cells/microl at 7 years after starting ART in analyses ignoring treatment discontinuations, and to 570 and 640 cells/microl, respectively, had all patients continued ART. However, even had ART been continued, an estimated 25, 9, 3, and 2% of patients with pretreatment CD4 cell counts of 200 or less, 201-350, 351-500, and more than 500 cells/microl would have had CD4 cell counts of 350 cells/microl or less after 7 years. CONCLUSION: If patients remain on ART, CD4 cell counts increase in most patients for at least 7 years. However, the substantial percentage of patients starting therapy at low CD4 cell counts who still had low CD4 cell counts after 7 years provides support for ART initiation at higher CD4 cell counts.
Source: AIDS
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: ADULT AIDS CLINICAL TRIALS UNIT (AACTU), G1019738922, G1033683653, G1065691059, G1116104148, G115468880, G1163454436, G1225594167, G1276011396, G1290643946, G1346130624, G1410941943, G1471808148, G1534260048, G1615307613, G161582775, WASHINGTON UNIVERSITY AIDS CLINICAL TRIALS UNIT, G1681955143, U.T. SOUTHWESTERN ADULT AIDS CLINICAL TRIALS UNIT, G1788832858, G1840998190, G1843845992, G1944963898, Methods for Analysis with Missing and/or Censored Data and for Causal Inference, G1976846336, G2027736814, G2049085317, G2069435444, G2239548760, G225176404, G226144467, G2351993143, G2365124469, G2368841045, G2381598486, G2416365291, G2423573027, G2709153970, General Clinical Research Center, University of North Carolina AIDS Clinical Trials Unit (UNC ACTU), G286338745, G2886248756, G2916982757, ADULT AIDS CLINICAL TRIALS UNIT, G2924810132, G2987980373, G299859194, G3041236093, G3206835426, G3206931443, G3245214449, G3277483280, G3306674280, ADULT AIDS CLINICAL TRIALS UNIT (ACTU), G3627057502, G3672534956, G367367271, G373348672, G3786797641, UW Clinical HIV Integrated Research Program, G387124574, G3935416247, G3955098203, G3964108010, ADULT AIDS CLINICAL TRIALS UNIT, G4122054131, GENERAL CLINICAL RESEARCH CENTER, General Clinical Research Center, STATISTICAL METHODS IN AIDS RESEARCH, G4205250407, General Clinical Research Center, G4597465377, Methods for Long-Term Follow-Up of HIV-Infected Patients, General Clinical Research Center, U of Colorado Center for AIDS Research, G513125418, ADULT THERAPEUTIC CLINICAL TRIALS PROGRAM IN AIDS, G5268332287, General Clinical Research Center, ADULT ACTG CENTRAL GROUP, G5456583408, Statistical and Data Management Center for the AIDS Clinical Trials Group, General Clinical Research Center, ADULT AIDS CLINICAL TRIAL UNIT, G6103943158, G610689301, G650174051, Partners Healthcare Systems/Harvard Medical School/Boston Medical Center AIDS CTU, G661928818, ADULT AIDS CLINICAL TRIALS UNIT, AIDS CLINICAL TRIALS UNIT, Partners Healthcare Systems/Harvard Medical School/Boston Medical Center AIDS CTU, G7348756, HAWAII ACTU - ADULT THERAPEUTIC CLINICAL TRIALS PROGRAM, HIV/AIDS Clinical Trials Unit, G7754570087, ADULT AIDS CLINICAL TRIALS UNIT, G8124278128, G845393165, ADULT THERAPEUTIC CLINICAL TRIALS PROGRAM FOR HIV/AIDS, G898609324, G9000008948, Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections, Center for AIDS Research at Emory University, Statistical and Data Management Center (SDMC), Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections (ACTG), Penn Center for AIDS Research, The University of North Carolina Center for AIDS Research, Harvard University Center for AIDS Research, MIAMI ADULT AIDS CLINICAL TRIALS GROUP, AACTG, ADULT AIDS CLINICAL TRIALS UNIT, G964886957, Bridging the Gap HIV Trials and Clinical Practice, G986646304
OpenAlex ID: W1990260535