CD4 Cell Counts of 800 Cells/mm3 or Greater After 7 Years of Highly Active Antiretroviral Therapy Are Feasible in Most Patients Starting With 350 Cells/mm3 or Greater

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Abstract
Objective: CD4 cell count changes in therapy-naive patients were investigated during 7 years of highly active antiretroviral therapy (HAART) in an observational cohort. Methods: Three endpoints were studied: (1) time to ≥800 CD4 cells/mm3 in 5299 therapy-naive patients starting HAART, (2) CD4 cell count changes during 7 years of uninterrupted HAART in a subset of 544 patients, and (3) reaching a plateau in CD4 cell restoration after 5 years of HAART in 366 virologically suppressed patients. Results: Among patients with 500 copies/mL and age ≥50 years were associated with lesser increases in CD4 cell counts between 6 months and 7 years. Having reached ≥800 CD4 cells/mm3 at 5 years, age ≥50 years, and ≥1 HIV RNA measurement >1000 copies/mL between 5 and 7 years were associated with a plateau in CD4 cell restoration. Conclusions: Restoration to CD4 cell counts ≥800 cells/mm3 is feasible within 7 years of HAART in most HIV-infected patients starting with ≥350 cells/mm3 and achieving sufficient suppression of viral replication. Particularly in patients ≥50 years of age, it may be beneficial to start earlier than current guidelines recommend.

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