TY - GEN T1 - Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4+ T-cell recovery once HIV-1 suppression is achieved? AU - Jarrin, Inma AU - Pantazis, Nikos AU - Dalmau, Judith AU - Phillips, Andrew N. AU - Olson, Ashley AU - Mussini, Cristina AU - Boufassa, Faroudy AU - Costagliola, Dominique AU - Porter, Kholoud AU - Blanco, Juliá AU - Amo, Julia Del AU - Martinez-Picado, Javier AB - Objective: This article compares trends in CD4+ T-cell recovery and proportions achieving optimal restoration (≥500 cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors. Methods: We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4+ less than 200 cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration. Results: Of 4024 individuals, 294 (7.3%) were classified as rapid progressors. At the same CD4+ T-cell count at cART start (baseline), rapid progressors experienced faster CD4+ T-cell increases than nonrapid progressors in first month [difference (95% confidence interval) in mean increase/month (square root scale): 1.82 (1.61; 2.04)], which reversed to slightly slower increases in months 1–18 [−0.05 (−0.06; −0.03)] and no significant differences in 18–60 months [−0.003 (−0.01; 0.01)]. Percentage achieving optimal restoration was significantly lower for rapid progressors than nonrapid progressors at months 12 (29.2 vs. 62.5%) and 36 (47.1 vs. 72.4%) but not at month 60 (70.4 vs. 71.8%). These differences disappeared after adjusting for baseline CD4+ T-cell count: odds ratio (95% confidence interval) 0.86 (0.61; 1.20), 0.90 (0.38; 2.17) and 1.56 (0.55; 4.46) at months 12, 36 and 60, respectively. Conclusion: Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4+ T-cell counts than nonrapid progressors, but are less likely to achieve optimal restoration during the first 36 months after cART, mainly because of lower CD4+ T-cell counts at cART initiation. KW - Humans KW - Female KW - Male KW - Adult KW - Middle Aged KW - Young Adult KW - Time Factors KW - Cohort Studies KW - CD4 Lymphocyte Count KW - HIV Infections/drug therapy KW - Viral Load KW - Antiretroviral Therapy Highly Active KW - CD4-Positive T-Lymphocytes/immunology KW - Disease Progression KW - Anti-Retroviral Agents/therapeutic use KW - HIV Infections/pathology KW - HIV-1/isolation & purification KW - 610 Medizin PY - 2015 LA - eng PB - Robert Koch-Institut, Infektionsepidemiologie VL - 29 IS - 17 DO - 10.1097/QAD.0000000000000805 ER -