Predictors of Long‐Term Increase in CD4+Cell Counts in Human Immunodeficiency Virus–Infected Patients Receiving a Protease Inhibitor–Containing Antiretroviral Regimen

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Abstract
The temporal relationships between plasma human immunodeficiency virus (HIV) RNA levels and evolution of CD4+ cell counts was studied, using a 2 slope longitudinal mixed model, in 988 patients prospectively enrolled at the initiation of a protease inhibitor-containing regimen of antiretroviral therapy. The short-term slope (baseline through month 4) for mean change in CD4+ cell count was +21.2 cells/mm3/month, and the long-term slope (month 4 through month 24) was +5.5 cells/mm3/month. Compared with results from patients without viral response, the long-term slope was 2.5 cells/mm3/month higher in patients who had plasma HIV RNA levels of P < .001). It was significantly lower after a rebound in plasma HIV RNA level to ⩾500 copies/mL (P < .0001), varied according to plasma HIV RNA level at the time of rebound, and was negative only when the plasma HIV RNA level at rebound was ⩾10,000 copies/mL. If CD4+ cell counts can remain elevated despite virologic treatment failure, such a discrepant response may be transient in patients who have a high plasma HIV RNA level at the time of treatment failure.

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