To assess CD4+ recovery after combined antiretroviral therapy (cART) initiation with sustained virologic control.
Cohort study based on the French Hospital Database on HIV (FHDH-ANRS CO4).
We selected naive HIV-1-infected individuals initiating cART between 2006 and 2014 with CD4+ cell counts less than 500 cells/μl who achieved virologic control, defined as two consecutive viral loads less than 50 copies/ml. We estimated the cumulative incidence of CD4+ recovery at least 500 cells/μl and identified associated factors, considering ‘virologic failure,’ ‘loss to follow-up’ and ‘death’ as competing events.
We analyzed 6050 individuals with a median follow-up of 14.2 months since virologic control. The cumulative incidence for CD4+ recovery after 6 years of virologic control reached 69.7%. The main factor associated with CD4+ recovery was the CD4+ count at treatment initiation [subdistribution hazard ratio (sHR) 9.64, 95% confidence interval (95% CI) 8.12–11.43 for CD4+ cell counts between 350 and 500 cells/μl compared with CD4+ cell counts <100 cells/μl). A higher CD4+/CD8+ ratio at initiation was also independently associated with a higher probability of CD4+ recovery [sHR 1.67; 95% CI 1.34-2.09] for a CD4+/CD8+ ratio ≥1.00 vs. < 0.30). Higher viral load at initiation was also associated with a higher probability of CD4+ recovery, whereas time to viral suppression was not.
After 6 years of sustained virologic control, a large majority of the population achieved CD4+ recovery. A higher CD4+ cell count at initiation was a strong predictor of CD4+ recovery and, to a lesser extent, a higher CD4+/CD8+ ratio at initiation. These results confirm the necessity of early treatment.
aINSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique
bAPHP, Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires Paris Nord site Bichat-Claude Bernard, Université Paris Diderot, INSERM U 1137 IAME, PRES Sorbonne Paris-Cité
cAPHP, Service de virologie, Hôpital St Louis, Université Paris Diderot
dAPHP, Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, Université Paris Descartes, Sorbonne Paris-Cité, Paris
eUMR1027, Université de Toulouse, UPS, Inserm, Toulouse, Service des Maladies Infectieuses et Tropicales, CHU de la Martinique, Fort de France
fAPHP, Hôpital Cochin, Université Paris Descartes, Sorbonne Paris-Cité
gINSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM Transfert, Paris
hInstitut Hospitalo-Universitaire (IHU) - Méditerranée Infection, Marseille
iInfectious Disease Departement, APHP, Hôpital Raymond Poincaré, Garches
jAPHP, Hôpital Bicêtre, Le Kremlin-Bicêtre
kAPHP, Hôpital Européen George Pompidou, Université Paris Descartes, Sorbonne Paris-Cité, Paris, France.
Correspondence to Hélène Roul, INSERM U1136, 56 boulevard Vincent Auriol, CS 81393 75646 Paris Cedex 13, France. E-mail: email@example.com
Received 26 June, 2018
Accepted 3 August, 2018
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