HIV Patients with Rapid Disease Progression May Have Worse Immune Recovery

People with HIV who experience fast disease progression with a rapid drop in their CD4 T-cell count may be less likely to regain a normal CD4 level after starting antiretroviral therapy (ART), according to research from the CASCADE Collaboration published in the November 2015 edition of AIDS.

Inma Jarrin from Instituto de Salud Carlos III in Madrid and colleagues looked at trends in CD4 cell recovery and the proportion of people achieving optimal restoration (defined as >500 cells/mm³) after achieving viral suppression on combination ART, comparing those with typical versus unusually rapid CD4 cell declines.

The analysis included 4024 participants in CASCADE Collaboration cohorts. CASCADE is a collaboration of 29 cohorts of people in Europe, Australia, Canada, and Africa with well-estimated dates of HIV seroconversion. Of these, 294 people (7.3%) were classified as rapid progressors, defined as falling below 200 cells/mm³ within a year after seroconversion. 

Results

• Among people with the same CD4 count at baseline, rapid progressors saw significantly faster CD4 cell increases during the first month on ART compared to typical progressors.
• But after the first month and continuing through month 18, the rapid progressors had slightly slower CD4 cell increases compared to typical progressors.
• From month 18 through month 60, there were no significant differences in CD4 cell recovery according to progression category.
• Overall, rapid progressors were significantly less likely to achieve optimal CD4 cell levels than typical progressors at month 12 (29.2% vs 62.5%) and month 36 (47.1% vs 72.4%).
• By month 60, there was no longer a significant difference (70.4% vs. 71.8%, respectively).
• However, these significant differences disappeared after adjusting for baseline CD4 cell level, with odds ratios of 0.86, 0.90, and 1.56, respectively, at months 12, 36, and 60.

Based on these findings, the researchers concluded, "Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4 T-cell counts than non-rapid progressors, but are less likely to achieve optimal restoration during the first 36 months after combination ART, mainly because of lower CD4 T-cell counts at c combination ART initiation."

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Reference

I Jarrin, N Pantazis N, J Dalmau, et al. (CASCADE Collaboration in EuroCoord). Does rapid HIV disease progression prior to combination antiretroviral therapy hinder optimal CD4+ T-cell recovery once HIV-1 suppression is achieved? AIDS 29(17):2323-2333. November 2015.