CD4+ T-cell recovery after initiation of antiretroviral therapy in a resource-limited setting: A prospective cohort analysis

Abstract

Background: CD4+ T-cell count recovery after antiretroviral therapy (ART) initiation is associated with improved health outcomes. It is unknown how the CD4+ T-cell counts of African HIV patients recover following ART initiation. Methods: We examined CD4+ T-cell count recovery in a large cohort of HIV-positive patients initiating ART in Uganda between 2004 and 2011. We categorized patients according to their CD4 + T-cell count at ART initiation. All patients received CD4 + T-cell count evaluations on a biannual basis. We used quantile regression to model the recovery of CD4+ T-cells during ART. Results: A total of 5,271 patients aged ≥14 years at baseline were included. The median number of CD4+ T-cell count measurements was 6 (IQR 4-8), and vital status at censoring was known in 97.2% of individuals. Most CD4 + T-cell count recovery occurred within the first 12 months, with marginal increases beyond 18 months and stabilization after 5 years. The strongest predictor of CD4+ T-cell count recovery was baseline CD4+ T-cell count. After 5 years on treatment, the median CD4 + T-cell count was 334 cells/mm3 for patients initiating ART with <100 cells/mm3. Only those initiating ART with >200 cells/mm3 reached a 5-year median >500 cells/mm3. Adolescents had the most robust CD4+ T-cell count recovery with a median increase after 12 months that was 109 cells/mm3 greater than those initiating ART at age ≥50 years. Conclusions: In individuals from a resource-limited setting, baseline CD4+ T-cell count was highly predictive of the maximum CD4+ T-cell count level achieved while on ART. ©2014 International Medical Press.