ArticleAIDS research and therapy2008
Sub-optimal CD4 reconstitution despite viral suppression in an urban cohort on antiretroviral therapy (ART) in sub-Saharan Africa: frequency and clinical significance.
Article in AIDS research and therapy, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 2 of them syntheses that pooled it.
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Who cites it
34 citing papers in PubMed, 2 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- Discordant Immune Response with Antiretroviral Therapy in HIV-1: A Systematic Review of Clinical Outcomes.PloS one · 2016Pooled it
- Pooled it
- Efficacy and safety of Mianyi granules (+mianyi+) for reversal of immune nonresponse following antiretroviral therapy of human immunodeficiency virus-1: a randomized, double-blind, multi-center, placebo-controlled trial.Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan · 2022Trial
- Atorvastatin reduces T-cell activation and exhaustion among HIV-infected cART-treated suboptimal immune responders in Uganda: a randomised crossover placebo-controlled trial.Tropical medicine & international health : TM & IH · 2015Trial
- Low antigen-specific CD4 T-cell immune responses despite normal absolute CD4 counts after long-term antiretroviral therapy an African cohort.Immunology letters · 2014Trial
- Trial
- Analysis of the clinical characteristics of poor immunological reconstitution in AIDS patients after long-term antiviral therapy in Xinjiang, China.BMC immunology · 2025Article
- Longitudinal patients' cohorts for impactful research and HIV care at the Infectious Diseases Institute.African health sciences · 2022Article
- Immunovirological discordance among female sex workers who start antiretroviral therapy in Burkina Faso.BMC infectious diseases · 2022Article
- CD4+ cell count recovery after initiation of antiretroviral therapy in HIV-infected Ethiopian adults.PloS one · 2022Article
- Characteristics of suboptimal immune response after initiating antiretroviral therapy among people living with HIV with a pre-treatment CD4 T cell count <200 cells/mmJournal of virus eradication · 2020Article
- Effects of Early and Delayed Antiretroviral Therapy on Plasma Anti-CD4 Autoreactive IgG and Its Association With CD4Frontiers in pharmacology · 2020Article
- Article
- Clinical characteristics of HIV-1-infected patients with high levels of plasma interferon-γ: a multicenter observational study.BMC infectious diseases · 2019Observational
- Immunological outcomes of Tenofovir versus Zidovudine-based regimens among people living with HIV/AIDS: a two years retrospective cohort study.AIDS research and therapy · 2017Article
- Clinical Outcomes of TenofovirThe open AIDS journal · 2017Article
- Frequency and impact of suboptimal immune recovery on first-line antiretroviral therapy within the International Epidemiologic Databases to Evaluate AIDS in East Africa.AIDS (London, England) · 2016Article
- A multi-institutional study of clinicopathological features and molecular epidemiology of epidermal growth factor receptor mutations in lung cancer patients living with human immunodeficiency virus infection.Journal of cancer research and clinical oncology · 2015Article
- Mortality and immunological recovery among older adults on antiretroviral therapy at a large urban HIV clinic in Kampala, Uganda.Journal of acquired immune deficiency syndromes (1999) · 2014Article
- High rates of tuberculosis in patients accessing HAART in rural South Africa.Journal of acquired immune deficiency syndromes (1999) · 2014Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundA proportion of individuals who start antiretroviral therapy (ART) fail to achieve adequate CD4 cell reconstitution despite sustained viral suppression. We determined the frequency and clinical significance of suboptimal CD4 reconstitution despite viral suppression (SO-CD4) in an urban HIV research cohort in Kampala, Uganda.
methodsWe analyzed data from a prospective research cohort of 559 patients initiating ART between 04/04-04/05. We described the patterns of SO-CD4 both in terms of:- I) magnitude of CD4 cell increase (a CD4 count increase < 50 CD4 cells/microl at 6 months, <100 cells/microl at 12 months; and <200 cells/microl at 24 months of ART) and II) failure to achieve a CD4 cell count above 200 cells/microl at 6,12 and 24 months of ART. Using criteria I) we used logistic regression to determine the predictors of SO-CD4. We compared the cumulative risk of clinical events (death and/or recurrent or new AIDS-defining illnesses) among patients with and without SO-CD4.
resultsOf 559 patients initiating ART, 386 (69%) were female. Median (IQR) age and baseline CD4 counts were 38 yrs (33-44) and 98 cells/microl (21-163) respectively; 414 (74%) started a d4T-based regimen (D4T+3TC+NVP) and 145 (26%) a ZDV-based regimen (ZDV+3TC+EFV). After 6, 12 and 24 months of ART, 380 (68%), 339 (61%) and 309 (55%) had attained and sustained HIV-RNA viral suppression. Of these, 78 (21%), 151 (45%) and 166 (54%) respectively had SO-CD4 based on criteria I), and 165(43%), 143(42%) and 58(19%) respectively based on criteria II). With both criteria combined, 56 (15%) and 129 (38%) had SO-CD4 at 6 and 12 months respectively. A high proportion (82% and 58%) of those that had SO-CD4 at 6 months (using criteria I) maintained SO-CD4 at 12 and 24 months respectively. There were no statistically significant differences in the incidence of clinical events among patients with [19/100PYO (12-29)] and without SO-CD4 [23/100PYO (19-28)].
conclusionUsing criteria I), the frequency of SO-CD4 was 21% at 6 months. Majority of patients with SO-CD4 at 6 months maintained SO-CD4 up to 2 years. We recommend studies of CD4 T-cell functional recovery among patients with SO-CD4.
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Registered trials
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