Measurement of naive CD4 cells reliably predicts potential for immune reconstitution in HIV.

TitleMeasurement of naive CD4 cells reliably predicts potential for immune reconstitution in HIV.
Publication TypeJournal Article
Year of Publication2010
AuthorsSchacker TW, Bosch RJ, Bennett K, Pollard R, Robbins GK, Collier AC, Gulick RM, Spritzler J, Mildvan D
Corporate AuthorsAIDS Clinical Trials Group
JournalJ Acquir Immune Defic Syndr
Volume54
Issue1
Pagination59-62
Date Published2010 May 1
ISSN1944-7884
KeywordsAdult, Anti-HIV Agents, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes, Female, HIV Infections, Humans, Male, Prognosis, Treatment Outcome, Viral Load
Abstract

BACKGROUND: Pathogenesis studies show that naive CD4 cells are preferentially depleted in lymphoid tissues during HIV infection, and studies of advanced patients suggest levels of naive CD4 cells in blood correlate to total CD4 cells after starting antiretroviral therapy (ARV). We hypothesized that measuring naive CD4 cells in blood in people at earlier stages of disease would identify those at highest risk for poor CD4 reconstitution who may benefit from earlier initiation of ARV.

METHODS AND FINDINGS: We identified 348 patients from multiple AIDS Clinical Trials Group studies who were ARV naive, had a CD4 count between 200 and 500 cells per microliter, a measure of pretreatment-naive CD4 percent, and serial follow-up measures of CD4 count and plasma HIV RNA after starting ARV. We used logistic regression to model the ability of naive CD4 percent to predict 100 and 200 CD4 cell increases after 24 months of therapy. After controlling for baseline viral load and demographic variables, baseline naive but not total CD4 cell count strongly predicted CD4 cell increases. Lower baseline naive CD4 percent was associated with greater time spent at lower CD4 T-cell counts after initiating ARV.

CONCLUSIONS: Measurement of naive CD4 percent in patients can identify those least likely to reconstitute immunity, who may benefit from earlier ARV treatment.

DOI10.1097/QAI.0b013e3181c96520
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID20182359
PubMed Central IDPMC2955357
Grant ListAI28246 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
AI38885 / AI / NIAID NIH HHS / United States
AI46370 / AI / NIAID NIH HHS / United States
AI54232 / AI / NIAID NIH HHS / United States
AI68634 / AI / NIAID NIH HHS / United States
AI68636 / AI / NIAID NIH HHS / United States
K24 AI051966 / AI / NIAID NIH HHS / United States
K24 AI056986 / AI / NIAID NIH HHS / United States
K24 AI056986-01 / AI / NIAID NIH HHS / United States
R01 AI054232 / AI / NIAID NIH HHS / United States
R01 AI054232-01A2 / AI / NIAID NIH HHS / United States