Document Detail


Enhanced CD4+ T-cell recovery with earlier HIV-1 antiretroviral therapy.
MedLine Citation:
PMID:  23323898     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The relationship between the timing of the initiation of antiretroviral therapy (ART) after infection with human immunodeficiency virus type 1 (HIV-1) and the recovery of CD4+ T-cell counts is unknown.
METHODS: In a prospective, observational cohort of persons with acute or early HIV-1 infection, we determined the trajectory of CD4+ counts over a 48-month period in partially overlapping study sets: study set 1 included 384 participants during the time window in which they were not receiving ART and study set 2 included 213 participants who received ART soon after study entry or sometime thereafter and had a suppressed plasma HIV viral load. We investigated the likelihood and rate of CD4+ T-cell recovery to 900 or more cells per cubic millimeter within 48 months while the participants were receiving viral-load-suppressive ART.
RESULTS: Among the participants who were not receiving ART, CD4+ counts increased spontaneously, soon after HIV-1 infection, from the level at study entry (median, 495 cells per cubic millimeter; interquartile range, 383 to 622), reached a peak value (median, 763 cells per cubic millimeter; interquartile range, 573 to 987) within approximately 4 months after the estimated date of infection, and declined progressively thereafter. Recovery of CD4+ counts to 900 or more cells per cubic millimeter was seen in approximately 64% of the participants who initiated ART earlier (≤4 months after the estimated date of HIV infection) as compared with approximately 34% of participants who initiated ART later (>4 months) (P<0.001). After adjustment for whether ART was initiated when the CD4+ count was 500 or more cells per cubic millimeter or less than 500 cells per cubic millimeter, the likelihood that the count would increase to 900 or more cells per cubic millimeter was lower by 65% (odds ratio, 0.35), and the rate of recovery was slower by 56% (rate ratio, 0.44), if ART was initiated later rather than earlier. There was no association between the plasma HIV RNA level at the time of initiation of ART and CD4+ T-cell recovery.
CONCLUSIONS: A transient, spontaneous restoration of CD4+ T-cell counts occurs in the 4-month time window after HIV-1 infection. Initiation of ART during this period is associated with an enhanced likelihood of recovery of CD4+ counts. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
Authors:
Tuan Le; Edwina J Wright; Davey M Smith; Weijing He; Gabriel Catano; Jason F Okulicz; Jason A Young; Robert A Clark; Douglas D Richman; Susan J Little; Sunil K Ahuja
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  368     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-17     Completed Date:  2013-01-23     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  218-30     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Anti-Retroviral Agents / administration & dosage*,  adverse effects,  therapeutic use
CD4 Lymphocyte Count*
CD4-Positive T-Lymphocytes / physiology*
Cohort Studies
Disease Progression
Drug Administration Schedule
Female
HIV Infections / drug therapy*,  immunology
HIV-1* / genetics,  isolation & purification
Humans
Male
Middle Aged
Observation
RNA, Viral / blood
Time Factors
Viral Load
Grant Support
ID/Acronym/Agency:
AI007384/AI/NIAID NIH HHS; AI077304/AI/NIAID NIH HHS; AI080193/AI/NIAID NIH HHS; AI096113/AI/NIAID NIH HHS; AI43638/AI/NIAID NIH HHS; AI69432/AI/NIAID NIH HHS; AI74621/AI/NIAID NIH HHS; MH083552/MH/NIMH NIH HHS; MH62512/MH/NIMH NIH HHS; P01 AI074621/AI/NIAID NIH HHS; P01 AI080193/AI/NIAID NIH HHS; P30 AI036214/AI/NIAID NIH HHS; P30 MH062512/MH/NIMH NIH HHS; R01 MH083552/MH/NIMH NIH HHS; R21 AI077304/AI/NIAID NIH HHS; R37 AI046326/AI/NIAID NIH HHS; R37 AI046326/AI/NIAID NIH HHS; T32 AI007384/AI/NIAID NIH HHS; T32 GM007309/GM/NIGMS NIH HHS; U01 AI043638/AI/NIAID NIH HHS; U01 AI069432/AI/NIAID NIH HHS; U19 AI096113/AI/NIAID NIH HHS; UL1 RR025767/RR/NCRR NIH HHS; UL1 TR000149/TR/NCATS NIH HHS; UL1TR000149/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Anti-Retroviral Agents; 0/RNA, Viral
Comments/Corrections
Comment In:
N Engl J Med. 2013 Jan 17;368(3):279-81   [PMID:  23323905 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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