The paradox of incomplete CD4 + cell count restoration despite successful antiretroviral treatment and the need to start highly active antiretroviral therapy early

Clinical Infectious Diseases

Volumn 48, Issue 6, 2009, Pages 795-797

  Julg, Boris ^a   Walker, Bruce D ^a,b,c  

^a MASSACHUSETTS INSTITUTE OF TECHNOLOGY   (United States)

^b HOWARD HUGHES MEDICAL INSTITUTE   (United States)

^c MASSACHUSETTS GENERAL HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIRETROVIRUS AGENT; VIRUS RNA;

CD4 LYMPHOCYTE COUNT; FOLLOW UP; HIGHLY ACTIVE ANTIRETROVIRAL THERAPY; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; PRACTICE GUIDELINE; PRIORITY JOURNAL; REVIEW; TREATMENT DURATION; VIRUS LOAD; HUMAN; IMMUNOLOGY; NOTE;

ANTIRETROVIRAL THERAPY, HIGHLY ACTIVE; CD4 LYMPHOCYTE COUNT; HIV INFECTIONS; HUMANS;

EID: 62449299222     PISSN: 10584838     EISSN: None     Source Type: Journal    
DOI: 10.1086/597094     Document Type: Review

References (18)

1. + T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract. I Exp Med 2004;200:749-59.
2. + lymphocyte counts and the risk of progression to AIDS. Veterans Affairs Cooperative Study Group on AIDS. N Engl J Med 1996; 334:426-31.
3. Battegay M, Nuesch R, Hirschel B, Kautmann GR. Immunological recovery and antiretroviral therapy in HIV-1 infection. Lancet Infect Dis 2006;6:280-7.
4. Ledergerber B, Egger M, Opravil M, et al. Clinical progression and virological failure on highly active antiretroviral therapy in HIV-1 patients: a prospective cohort study. Swiss HIV Cohort Study. Lancet 1999;353:863-8.
5. Hakim FT, Cepeda R, Kaimei S, et al. Constraints on CD4 recovery postchemotherapy in adults: thymic insufficiency and apoptotic decline of expanded peripheral CD4 cells. Blood 1997;90:3789-98.
6. Pakker NG, Notermans DW, de Boer RJ, et al. Biphasic kinetics of peripheral blood T cells after triple combination therapy in HIV-1 infection: a composite of redistribution and proliferation. Nat Med 1998;4:208-14.
7. Ledergerber B, Lundgren ID, Walker AS, et al. Predictors of trend in CD4-positive T-cell count and mortality among HIV-1-infected individuals with virological failure to all three antiretroviral-drug classes. Lancet 2004;364:51-62.
8. Mocroft A, Phillips AN, Gatell I, et al. Normalisation of CD4 counts in patients with HIV-1 infection and maximum virological suppression who are taking combination antiretroviral therapy: an observational cohort study. Lancet 2007;370:407-13.
9. Egger M, May M, Chene G, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002; 360:119-29.
10. + cell count 6 years after commencement of highly active antiretroviral therapy in persons with sustained virologic suppression. Clin Infect Dis 2007;44:441-6.
11. + T cell count recovery in HIV type 1-infected patients is independent of class of antiretroviral therapy. Clin Infect Dis 2008;47:1093-101.
12. + count and risk of non-AIDS diseases following initial treatment for HIV infection. AIDS 2008;22:841-8.
13. Kaufmann GR, Furrer H, Ledergerber B, et al. Characteristics, determinants, and clinical relevance of CD4 T cell recovery to <500 cells/μL in HIV type 1-infected individuals receiving potent antiretroviral therapy. Clin Infect Dis 2005;41:361-72.
14. + cell count restoration in HIV-infected patients receiving long-term antiretroviral treatment. Clin Infect Dis 2009;48:787-94 (in this issue).
15. Du DL, Volpe DA, Grieshaber CK, Murphy MJ Jr. In vitro toxicity of 3′-azido-3′-deoxythymidine, carbovir and 2′,3′- didehydro-2′,3′-dideoxythymidine to human and murine haematopoietic progenitor cells. Br J Haematol 1992;80:437-45.
16. Karrer U, Ledergerber B, Furrer H, et al. Dose-dependent influence of didanosine on immune recovery in HIV-infected patients treated with tenofovir. AIDS 2005;19:1987-94.
17. Panel for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services, 2008:1-139. Available at: http://www.aidsinfo.nih.gov/ContentFiles/Adult andAdolescentGL.pdf. Accessed 9 December 2008.
18. European guidelines for the clinical management and treatment of HIV infected adults in Europe. European AIDS Clinical Society, 2008. Available at: http://www.eacs.eu/guide/index.htm. Accessed 9 December 2008.