ArticleThe New England journal of medicine2013
Enhanced CD4+ T-cell recovery with earlier HIV-1 antiretroviral therapy.
Article in The New England journal of medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04938518 (Investigation of the Impact of Inducible, Replication-competent Latent HIV-1 as an Impediment to HIV/AIDS Cure in the Context of Sustained Viral Suppression), which is not on this map. Cited by 236 papers.
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Investigation of the Impact of Inducible, Replication-competent Latent HIV-1 as an Impediment to HIV/AIDS Cure in the Context of Sustained Viral Suppression
Who cites it
236 citing papers in PubMed.
- Evaluating B/F/TAF at the first HIV-specialist appointment in antiretroviral naive persons living with HIV: the bifast study.BMC infectious diseases · 2026Trial
- Risk of severe bacterial infections including TB before and after immediate or deferred antiretroviral therapy: A multicenter, prospective, cohort study.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025Trial
- Clinical and Immunologic Outcomes After Immediate or Deferred Antiretroviral Therapy Initiation During Primary Human Immunodeficiency Virus Infection: The Sabes Randomized Clinical Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- The benefit of immediate compared with deferred antiretroviral therapy on CD4+ cell count recovery in early HIV infection.AIDS (London, England) · 2019Trial
- Risk Factors for Low CD4+ Count Recovery Despite Viral Suppression Among Participants Initiating Antiretroviral Treatment With CD4+ Counts > 500 Cells/mm3: Findings From the Strategic Timing of AntiRetroviral Therapy (START) Trial.Journal of acquired immune deficiency syndromes (1999) · 2019Trial
- Effect of valaciclovir on CD4 count decline in untreated HIV: an international randomized controlled trial.The Journal of antimicrobial chemotherapy · 2019Trial
- Trial
- Sustained Sexual Behavior Change After Acute HIV Diagnosis in Malawi.Sexually transmitted diseases · 2018Trial
- Ethics of treatment interruption trials in HIV cure research: addressing the conundrum of risk/benefit assessment.Journal of medical ethics · 2018Trial
- Size, Composition, and Evolution of HIV DNA Populations during Early Antiretroviral Therapy and Intensification with Maraviroc.Journal of virology · 2018Trial
- Post-treatment control or treated controllers? Viral remission in treated and untreated primary HIV infection.AIDS (London, England) · 2017Trial
- A randomized controlled clinical trial on the impact of CCR5 blockade with maraviroc in early infection on T-cell dynamics.Medicine · 2016Trial
- Antiretroviral Therapy for the Prevention of HIV-1 Transmission.The New England journal of medicine · 2016Trial
- Trial
- Low antigen-specific CD4 T-cell immune responses despite normal absolute CD4 counts after long-term antiretroviral therapy an African cohort.Immunology letters · 2014Trial
- Using CD4 percentage and age to optimize pediatric antiretroviral therapy initiation.Pediatrics · 2014Trial
- Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial.The Lancet. Infectious diseases · 2014Trial
- Mortality risk in patients with urological malignancies and human immunodeficiency virus (HIV) coinfection: A systematic review and meta-analysis of cohort studies.Cancer pathogenesis and therapy · 2026Review
- CD4-directed nanoblades enable selective genome editing in CD4EMBO molecular medicine · 2026Article
- Prevalence of and Time to Suboptimal Treatment Patterns Among People with HIV on Antiretroviral Therapy in the United States.AIDS and behavior · 2026Observational
176 more citing papers are in PubMed but not listed here.
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Authors and funding
11 authors.
Funding
Abstract
backgroundThe relationship between the timing of the initiation of antiretroviral therapy (ART) after infection with human immunodeficiency virus type 1 (HIV-1) and the recovery of CD4+ T-cell counts is unknown.
methodsIn a prospective, observational cohort of persons with acute or early HIV-1 infection, we determined the trajectory of CD4+ counts over a 48-month period in partially overlapping study sets: study set 1 included 384 participants during the time window in which they were not receiving ART and study set 2 included 213 participants who received ART soon after study entry or sometime thereafter and had a suppressed plasma HIV viral load. We investigated the likelihood and rate of CD4+ T-cell recovery to 900 or more cells per cubic millimeter within 48 months while the participants were receiving viral-load-suppressive ART.
resultsAmong the participants who were not receiving ART, CD4+ counts increased spontaneously, soon after HIV-1 infection, from the level at study entry (median, 495 cells per cubic millimeter; interquartile range, 383 to 622), reached a peak value (median, 763 cells per cubic millimeter; interquartile range, 573 to 987) within approximately 4 months after the estimated date of infection, and declined progressively thereafter. Recovery of CD4+ counts to 900 or more cells per cubic millimeter was seen in approximately 64% of the participants who initiated ART earlier (≤4 months after the estimated date of HIV infection) as compared with approximately 34% of participants who initiated ART later (>4 months) (P<0.001). After adjustment for whether ART was initiated when the CD4+ count was 500 or more cells per cubic millimeter or less than 500 cells per cubic millimeter, the likelihood that the count would increase to 900 or more cells per cubic millimeter was lower by 65% (odds ratio, 0.35), and the rate of recovery was slower by 56% (rate ratio, 0.44), if ART was initiated later rather than earlier. There was no association between the plasma HIV RNA level at the time of initiation of ART and CD4+ T-cell recovery.
conclusionsA transient, spontaneous restoration of CD4+ T-cell counts occurs in the 4-month time window after HIV-1 infection. Initiation of ART during this period is associated with an enhanced likelihood of recovery of CD4+ counts. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
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