Immunological control of HIV replication in the absence of treatment is associated with relative preservation of CD4 T cell counts. However recent studies have shown that, in most cases, levels of immune activation are still elevated compared to uninfected individuals, and the magnitude of immune activation is associated with the pace of attrition of peripheral blood CD4 T cells over time. A correlation with low-level HIV replication below the standard threshold of detection has also been reported. Eventually, CD4 T cell counts can fall to levels indicating that antiretroviral therapy (ART) should be initiated. As the response to treatment in this setting has not been well described, researchers from the US Military reviewed data from their cohort of HIV positive people in care and found sixty-two individuals who met the criteria for HIV controllers and had started combination ART. Six were defined as elite controllers (based on having three viral loads below the limit of detection for >12 months in the absence of treatment) and 56 were defined as viremic controllers (the same criteria but with a viral load threshold of 2000 copies/mL). CD4 T counts at the time of ART initiation were similar to those in a comparison group of non-controllers (376 vs 366 cells), but viral loads were significantly lower. Both the controllers and non-controllers experienced significant CD4 T cells gains after ART initiation with only a slight trend for smaller increases in the controllers (151 vs 197 cells after 12 months and 200 vs 230 cells after 24 months). The authors conclude: “Our results support the current treatment guidelines, which emphasize initiating HAART on the basis of CD4 cell count rather than viral load.”
Clinical Infectious Diseases 2010;50:000–000
DOI: 10.1086/651421
BRIEF REPORT
CD4 T Cell Count Reconstitution in HIV Controllers after Highly Active Antiretroviral Therapy
Jason F. Okulicz,1,3 Greg A. Grandits,1,4 Amy C. Weintrob,1,5 Michael L. Landrum,1,3 Anuradha Ganesan,1,2 Nancy F. Crum‐Cianflone,1,6 Brian K. Agan,1 and Vincent C. Marconi7
1Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, and 2Division of Infectious Diseases, National Naval Medical Center, Bethesda, Maryland; 3Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas; 4Division of Biostatistics, University of Minnesota, Minneapolis; 5Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC; 6Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, California; and 7Emory University School of Medicine, Atlanta, Georgia
Sixty‐two human immunodeficiency virus (HIV) controllers (6 elite and 56 viremic controllers) in the US Military Department of Defense HIV Natural History Study cohort initiated highly active antiretroviral therapy (HAART) and achieved statistically significant mean CD4 cell count increases, although the gains were lower than those in treated noncontrollers. HIV controllers experienced CD4 cell count reconstitution with HAART regardless of pretherapy viral load, including patients with undetectable viral loads at HAART initiation.
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