Risk Factors for Low CD4+ Count Recovery Despite Viral Suppression Among Participants Initiating Antiretroviral Treatment With CD4+ Counts > 500 Cells/mm3: Findings From the Strategic Timing of AntiRetroviral Therapy (START) Trial
BACKGROUND:Low CD4 recovery among HIV-positive individuals who achieve virologic suppression is common but has not been studied among individuals initiating treatment at CD4 counts of >500 cells/mm. SETTING:United States, Africa, Asia, Europe and Israel, Australia, Latin America. METHODS:Among pa...
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| Veröffentlicht in: | Journal of acquired immune deficiency syndromes (1999) 2019-05, Vol.81 (1), p.10-17 |
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| container_title | Journal of acquired immune deficiency syndromes (1999) |
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| creator | Boatman, Jeffrey A Baker, Jason V Emery, Sean Furrer, Hansjakob Mushatt, David M Sedláček, Dalibor Lundgren, Jens D Neaton, James D |
| description | BACKGROUND:Low CD4 recovery among HIV-positive individuals who achieve virologic suppression is common but has not been studied among individuals initiating treatment at CD4 counts of >500 cells/mm.
SETTING:United States, Africa, Asia, Europe and Israel, Australia, Latin America.
METHODS:Among participants randomized to immediate antiretroviral therapy (ART) in the Strategic Timing of AntiRetroviral Therapy trial, low CD4 recovery was defined as a CD4 increase of |
| doi_str_mv | 10.1097/QAI.0000000000001967 |
| format | Article |
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SETTING:United States, Africa, Asia, Europe and Israel, Australia, Latin America.
METHODS:Among participants randomized to immediate antiretroviral therapy (ART) in the Strategic Timing of AntiRetroviral Therapy trial, low CD4 recovery was defined as a CD4 increase of <50 cells/mm from baseline after 8 months despite viral load of ≤200 copies/mL. Risk factors for low recovery were investigated with logistic regression.
RESULTS:Low CD4 recovery was observed in 39.7% of participants. Male sex [odds ratio (OR), 1.53; P = 0.007], lower screening CD4 cell counts (OR, 1.09 per 100 fewer cells/mm; P = 0.004), higher baseline CD8 cell counts (OR, 1.05 per 100 more cells/mm; P < 0.001), and lower HIV RNA levels (OR, 1.93 per log10 decrease; P < 0.001) were associated with low CD4 recovery. D-dimer had a quadratic association with low CD4 recovery, with lowest odds occurring at 0.32 μg/mL. At lower HIV RNA levels, the odds of low CD4 recovery were elevated across the levels of screening CD4 count; but at higher HIV RNA levels, the odds of low CD4 recovery were higher among those with lower vs. higher screening CD4.
CONCLUSIONS:Low CD4 recovery is frequent among participants starting ART at high CD4 counts. Risk factors include male sex, lower screening CD4 cell counts, higher CD8 cell counts, and lower HIV RNA levels. More follow-up is required to determine the impact of low CD4 recovery on clinical outcomes.</description><identifier>ISSN: 1525-4135</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0000000000001967</identifier><identifier>PMID: 30664075</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; AIDS/HIV ; Anti-HIV Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; CD4 antigen ; CD4 Lymphocyte Count - statistics & numerical data ; CD4-Positive T-Lymphocytes - drug effects ; CD8 antigen ; Dimers ; Drug therapy ; Female ; HIV ; HIV Infections - drug therapy ; Human immunodeficiency virus ; Humans ; Logistic Models ; Male ; Recovery ; Ribonucleic acid ; Risk analysis ; Risk Factors ; RNA ; Screening ; Sex ; Sex Factors ; Sex ratio ; Sexually transmitted diseases ; Therapy ; Treatment Failure</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2019-05, Vol.81 (1), p.10-17</ispartof><rights>Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright Lippincott Williams & Wilkins Ovid Technologies May 1, 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3607-485468674ddedc26b88a4308bec0d1be613aa8288b3ed7cebdaf245b9fe526d43</citedby><cites>FETCH-LOGICAL-c3607-485468674ddedc26b88a4308bec0d1be613aa8288b3ed7cebdaf245b9fe526d43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30664075$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boatman, Jeffrey A</creatorcontrib><creatorcontrib>Baker, Jason V</creatorcontrib><creatorcontrib>Emery, Sean</creatorcontrib><creatorcontrib>Furrer, Hansjakob</creatorcontrib><creatorcontrib>Mushatt, David M</creatorcontrib><creatorcontrib>Sedláček, Dalibor</creatorcontrib><creatorcontrib>Lundgren, Jens D</creatorcontrib><creatorcontrib>Neaton, James D</creatorcontrib><creatorcontrib>INSIGHT START Study Group</creatorcontrib><creatorcontrib>for the INSIGHT START Study Group</creatorcontrib><title>Risk Factors for Low CD4+ Count Recovery Despite Viral Suppression Among Participants Initiating Antiretroviral Treatment With CD4+ Counts > 500 Cells/mm3: Findings From the Strategic Timing of AntiRetroviral Therapy (START) Trial</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>BACKGROUND:Low CD4 recovery among HIV-positive individuals who achieve virologic suppression is common but has not been studied among individuals initiating treatment at CD4 counts of >500 cells/mm.
SETTING:United States, Africa, Asia, Europe and Israel, Australia, Latin America.
METHODS:Among participants randomized to immediate antiretroviral therapy (ART) in the Strategic Timing of AntiRetroviral Therapy trial, low CD4 recovery was defined as a CD4 increase of <50 cells/mm from baseline after 8 months despite viral load of ≤200 copies/mL. Risk factors for low recovery were investigated with logistic regression.
RESULTS:Low CD4 recovery was observed in 39.7% of participants. Male sex [odds ratio (OR), 1.53; P = 0.007], lower screening CD4 cell counts (OR, 1.09 per 100 fewer cells/mm; P = 0.004), higher baseline CD8 cell counts (OR, 1.05 per 100 more cells/mm; P < 0.001), and lower HIV RNA levels (OR, 1.93 per log10 decrease; P < 0.001) were associated with low CD4 recovery. D-dimer had a quadratic association with low CD4 recovery, with lowest odds occurring at 0.32 μg/mL. At lower HIV RNA levels, the odds of low CD4 recovery were elevated across the levels of screening CD4 count; but at higher HIV RNA levels, the odds of low CD4 recovery were higher among those with lower vs. higher screening CD4.
CONCLUSIONS:Low CD4 recovery is frequent among participants starting ART at high CD4 counts. Risk factors include male sex, lower screening CD4 cell counts, higher CD8 cell counts, and lower HIV RNA levels. More follow-up is required to determine the impact of low CD4 recovery on clinical outcomes.</description><subject>Adult</subject><subject>AIDS/HIV</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count - statistics & numerical data</subject><subject>CD4-Positive T-Lymphocytes - drug effects</subject><subject>CD8 antigen</subject><subject>Dimers</subject><subject>Drug therapy</subject><subject>Female</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Recovery</subject><subject>Ribonucleic acid</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>RNA</subject><subject>Screening</subject><subject>Sex</subject><subject>Sex Factors</subject><subject>Sex ratio</subject><subject>Sexually transmitted diseases</subject><subject>Therapy</subject><subject>Treatment Failure</subject><issn>1525-4135</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9klFv0zAUhSMEYmPwDxC6Ei9DKJsdO4mzB6Sqo1CpEtAGeIyc5GbxlsTBdlb1D_M78NaBqj3gF1vWd865lk8QvKbkjJIsPf82W56Rg0WzJH0SHNOM8zAVgj_15ziKQ05ZfBS8sPbaMwnn2fPgiJEk4SSNj4Pfa2VvYCErp42FRhtY6S3ML_l7mOtpcLDGSt-i2cEl2lE5hB_KyA420zgatFbpAWa9Hq7gqzROVWqUg7OwHJRT0il_PxucMuiMvr0X5gal69E7_1SuPUiy8AFiQmCOXWfP-55dwEINtbewsDC6B9cibJyRDq9UBbnq79x1cx-wPgho0chxB6ebfLbO3_lAJbuXwbNGdhZfPewnwffFx3z-OVx9-bScz1ZhxRKShlzEPBFJyusa6ypKSiEkZ0SUWJGalphQJqWIhCgZ1mmFZS2biMdl1mAcJTVnJ8Hp3nc0-teE1hW9spV_kRxQT7aIaJqxLGU09ujbR-i1nszgpyuiiEWE0pRST_E9VRltrcGmGI3qpdkVlBR3PSh8D4rHPfCyNw_mU9lj_U_09-M9IPbAVncOjb3ppi2aokXZufb_3n8AkmPAWg</recordid><startdate>20190501</startdate><enddate>20190501</enddate><creator>Boatman, Jeffrey A</creator><creator>Baker, Jason V</creator><creator>Emery, Sean</creator><creator>Furrer, Hansjakob</creator><creator>Mushatt, David M</creator><creator>Sedláček, Dalibor</creator><creator>Lundgren, Jens D</creator><creator>Neaton, James D</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7T5</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20190501</creationdate><title>Risk Factors for Low CD4+ Count Recovery Despite Viral Suppression Among Participants Initiating Antiretroviral Treatment With CD4+ Counts > 500 Cells/mm3: Findings From the Strategic Timing of AntiRetroviral Therapy (START) Trial</title><author>Boatman, Jeffrey A ; Baker, Jason V ; Emery, Sean ; Furrer, Hansjakob ; Mushatt, David M ; Sedláček, Dalibor ; Lundgren, Jens D ; Neaton, James D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3607-485468674ddedc26b88a4308bec0d1be613aa8288b3ed7cebdaf245b9fe526d43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>AIDS/HIV</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral therapy</topic><topic>CD4 antigen</topic><topic>CD4 Lymphocyte Count - statistics & numerical data</topic><topic>CD4-Positive T-Lymphocytes - drug effects</topic><topic>CD8 antigen</topic><topic>Dimers</topic><topic>Drug therapy</topic><topic>Female</topic><topic>HIV</topic><topic>HIV Infections - drug therapy</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Recovery</topic><topic>Ribonucleic acid</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>RNA</topic><topic>Screening</topic><topic>Sex</topic><topic>Sex Factors</topic><topic>Sex ratio</topic><topic>Sexually transmitted diseases</topic><topic>Therapy</topic><topic>Treatment Failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boatman, Jeffrey A</creatorcontrib><creatorcontrib>Baker, Jason V</creatorcontrib><creatorcontrib>Emery, Sean</creatorcontrib><creatorcontrib>Furrer, Hansjakob</creatorcontrib><creatorcontrib>Mushatt, David M</creatorcontrib><creatorcontrib>Sedláček, Dalibor</creatorcontrib><creatorcontrib>Lundgren, Jens D</creatorcontrib><creatorcontrib>Neaton, James D</creatorcontrib><creatorcontrib>INSIGHT START Study Group</creatorcontrib><creatorcontrib>for the INSIGHT START Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boatman, Jeffrey A</au><au>Baker, Jason V</au><au>Emery, Sean</au><au>Furrer, Hansjakob</au><au>Mushatt, David M</au><au>Sedláček, Dalibor</au><au>Lundgren, Jens D</au><au>Neaton, James D</au><aucorp>INSIGHT START Study Group</aucorp><aucorp>for the INSIGHT START Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors for Low CD4+ Count Recovery Despite Viral Suppression Among Participants Initiating Antiretroviral Treatment With CD4+ Counts > 500 Cells/mm3: Findings From the Strategic Timing of AntiRetroviral Therapy (START) Trial</atitle><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle><addtitle>J Acquir Immune Defic Syndr</addtitle><date>2019-05-01</date><risdate>2019</risdate><volume>81</volume><issue>1</issue><spage>10</spage><epage>17</epage><pages>10-17</pages><issn>1525-4135</issn><eissn>1944-7884</eissn><abstract>BACKGROUND:Low CD4 recovery among HIV-positive individuals who achieve virologic suppression is common but has not been studied among individuals initiating treatment at CD4 counts of >500 cells/mm.
SETTING:United States, Africa, Asia, Europe and Israel, Australia, Latin America.
METHODS:Among participants randomized to immediate antiretroviral therapy (ART) in the Strategic Timing of AntiRetroviral Therapy trial, low CD4 recovery was defined as a CD4 increase of <50 cells/mm from baseline after 8 months despite viral load of ≤200 copies/mL. Risk factors for low recovery were investigated with logistic regression.
RESULTS:Low CD4 recovery was observed in 39.7% of participants. Male sex [odds ratio (OR), 1.53; P = 0.007], lower screening CD4 cell counts (OR, 1.09 per 100 fewer cells/mm; P = 0.004), higher baseline CD8 cell counts (OR, 1.05 per 100 more cells/mm; P < 0.001), and lower HIV RNA levels (OR, 1.93 per log10 decrease; P < 0.001) were associated with low CD4 recovery. D-dimer had a quadratic association with low CD4 recovery, with lowest odds occurring at 0.32 μg/mL. At lower HIV RNA levels, the odds of low CD4 recovery were elevated across the levels of screening CD4 count; but at higher HIV RNA levels, the odds of low CD4 recovery were higher among those with lower vs. higher screening CD4.
CONCLUSIONS:Low CD4 recovery is frequent among participants starting ART at high CD4 counts. Risk factors include male sex, lower screening CD4 cell counts, higher CD8 cell counts, and lower HIV RNA levels. More follow-up is required to determine the impact of low CD4 recovery on clinical outcomes.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>30664075</pmid><doi>10.1097/QAI.0000000000001967</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of acquired immune deficiency syndromes (1999), 2019-05, Vol.81 (1), p.10-17 |
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| language | eng |
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| source | MEDLINE; Journals@Ovid LWW Legacy Archive; Free E- Journals |
| subjects | Adult AIDS/HIV Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy CD4 antigen CD4 Lymphocyte Count - statistics & numerical data CD4-Positive T-Lymphocytes - drug effects CD8 antigen Dimers Drug therapy Female HIV HIV Infections - drug therapy Human immunodeficiency virus Humans Logistic Models Male Recovery Ribonucleic acid Risk analysis Risk Factors RNA Screening Sex Sex Factors Sex ratio Sexually transmitted diseases Therapy Treatment Failure |
| title | Risk Factors for Low CD4+ Count Recovery Despite Viral Suppression Among Participants Initiating Antiretroviral Treatment With CD4+ Counts > 500 Cells/mm3: Findings From the Strategic Timing of AntiRetroviral Therapy (START) Trial |
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