CD4+ T cell count recovery in HIV type 1-infected patients is independent of class of antiretroviral therapy

Abstract

Background. In recent years, treatment options for human immunodeficiency virus type 1 (HIV-1) infection have changed from nonboosted protease inhibitors (PIs) to nonnucleoside reverse-transcriptase inhibitors (NNRTIs) and boosted PI-based antiretroviral drug regimens, but the impact on immunological recovery remains uncertain. Methods. During January 1996 through May 2007, all patients in the Swiss HIV Cohort were included if they received the first combination antiretroviral therapy (cART) and had known baseline CD4+ T cell counts and HIV-1 RNA values (n = 3293). The mean (±SD) duration of follow-up was 26.8 ± 20.5 months. The follow-up time was limited to the duration of the first cART. CD4+ T cell recovery was analyzed in 3 different treatment groups: nonboosted PI, NNRTI, or boosted PI. The end point was the absolute increase of CD4+ T cell count in the 3 treatment groups after the initiation of cART. Results. Two thousand five hundred ninety individuals (78.7%) initiated a nonboosted-PI regimen, 452 (13.7%) initiated an NNRTI regimen, and 251 (7.6%) initiated a boosted-PI regimen. Absolute CD4 + T cell count increases at 48 months were as follows: in the nonboosted-PI group, from 210 to 520 cells/μL; in the NNRTI group, from 220 to 475 cells/μL; and in the boosted-PI group, from 168 to 511 cells/μL. In a multivariate analysis, the treatment group did not affect the response of CD4+ T cells; however, increased age, pretreatment with nucleoside reverse-transcriptase inhibitors, serological tests positive for hepatitis C virus, Centers for Disease Control and Prevention stage C infection, lower baseline CD4+ T cell count, and lower baseline HIV-1 RNA level were risk factors for smaller increases in CD4+ T cell count. Conclusion. CD4+ T cell recovery was similar in patients receiving nonboosted PI-, NNRTI-, and boosted PI-based cART. © 2008 by the Infectious Diseases Society of America. All rights reserved.