Long-Term Follow-Up of HIV-Infected Individuals Who Have Significant Increases in CD4+ Cell Counts during Antiretroviral Therapy

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Abstract
Background. Descriptions of the durability and consequences of immune reconstitution in patients who start highly active antiretroviral therapy (HAART) while severely immunosuppressed are limited. Methods. Patients with previous CD4+ cell counts 100 cells/mm3 on 2 separate occasions (measured sequentially at least 4 weeks apart), were enrolled in a prospective trial and observed every 16–32 weeks. Evaluations included assessments for new opportunistic complications, virologic (human immunodeficiency virus [HIV] RNA load) and immunologic (CD4+ cell count) responses, or death. Results. The median follow-up duration for 612 subjects was 184 weeks (range, 8–216 weeks). The rate of increase in CD4+ cell counts was ∼5.9 cells/mm3 every 8 weeks, with the degree of increase associated with the baseline HIV RNA load (40% (14 cases) occurred with higher than expected CD4+ cell counts. Conclusions. CD4+ cell count increases are related to virological control, with continuing increases seen in individuals who are immunosuppressed. Opportunistic illnesses and/or complications are infrequent but can occur at any time, even in patients who maintained an elevated CD4+ cell count.