The Naive CD4+ Count in HIV-1-infected Patients at Time of Initiation of Highly Active Antiretroviral Therapy is Strongly Associated with the Level of Immunological Recovery

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Abstract
Current antiretroviral therapy can induce considerable, sustained viral suppression followed by immunological recovery, in which naive CD4+ cells are important. Long-term immunological recovery was investigated during the first 3 y of highly active antiretroviral therapy (HAART) in 210 HIV-1-infected patients. The focus was on the naive CD4+ cell time course and associations between naive CD4+ cell counts and established prognostic markers. Total and naive CD4+ cell counts were measured using flow cytometry. The HIV-RNA detection limit was 20 copies/ml. During 36 months of HAART, the total CD4+ count followed a triphasic pattern, reflecting an initial phase of rapid redistribution from lymphoid tissues, followed by a slow increase, partially due to an increase in naive CD4+ cell count. From Month 18 onwards, both naive and total CD4+ cell counts stabilized, although viral suppression was sustained. There was no association between plasma viral load and the increase in naive CD4+ cell count. Importantly, baseline naive CD4+ cell count was significantly associated with the change in naive CD4+ cell count, suggesting that the naive cell count at baseline does influence the immunological recovery that can be obtained from treatment. Surprisingly, the naive CD4+ cell count tended to stabilize at a subnormal level after 18 months of HAART. This finding merits further investigation.

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