Effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy in HIV-1-positive subjects: Results from ACTG 384

Rajesh T. Gandhi, John Spritzler, Ellen Chan, David Asmuth, Benigno Rodriguez, Thomas C. Merigan, Martin S. Hirsch, Robert W. Shafer, Gregory K. Robbins, Richard B Pollard

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Abstract

OBJECTIVE: To assess the effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy (ART). METHODS: Nine hundred eighty antiretroviral-naive HIV-1+ subjects were randomized to start stavudine/didanosine or zidovudine/lamivudine with nelfinavir, efavirenz, or both nelfinavir and efavirenz. RESULTS: Greater CD4 cell recovery was associated with age of 40 years or younger, female sex, higher baseline naive/memory CD4 cell ratio, higher baseline virus load (VL), and virologic suppression (VS). Most subjects who maintained an undetectable VL had a substantial increase in CD4 cell count, but 13% of the subjects did not, even after 3 years of VS. Persistent T-cell activation was associated with lower CD4 cell recovery, even in subjects who achieved VS. Initial treatment assignment did not affect total CD4 cell recovery, naive/memory CD4 cell reconstitution, or decline in T-cell activation. In addition to CD4 cell recovery, B-cell counts rose substantially after ART initiation. CONCLUSIONS: In this large randomized trial, younger age, female sex, higher naive/memory CD4 cell ratio, higher baseline VL, and VS were associated with greater CD4 cell increase, whereas persistent T-cell activation was associated with impaired CD4 cell recovery after ART initiation. Initial treatment assignment did not affect CD4 cell reconstitution.

Original languageEnglish (US)
Pages (from-to)426-434
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume42
Issue number4
DOIs
StatePublished - Aug 2006

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Keywords

  • Antiretroviral therapy
  • CD4 cell recovery
  • HIV-1
  • Immunologic outcomes
  • Memory and naive CD4 cell subsets
  • T-cell activation

ASJC Scopus subject areas

  • Virology
  • Immunology

Cite this

Effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy in HIV-1-positive subjects : Results from ACTG 384. / Gandhi, Rajesh T.; Spritzler, John; Chan, Ellen; Asmuth, David; Rodriguez, Benigno; Merigan, Thomas C.; Hirsch, Martin S.; Shafer, Robert W.; Robbins, Gregory K.; Pollard, Richard B.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 42, No. 4, 08.2006, p. 426-434.

Research output: Contribution to journalArticle