Predictors for Changes in CD4 Cell Count 7 Years after Starting HAART

There are few data on changes in CD4 cell count 4-5 years following the start of HAART in treatment-naive patients. Using the Netherlands ATHENA national observational cohort, Dutch researchers selected 840 treatment-naive HIV patients who had started HAART between January 1997 and July 1998 and for whom 7 years of follow-up data were available.

Linear regression models were used to find predictors for changes in CD4 cell count at 7 years after starting HAART.

Results

·         Median CD4 cell count at the start of HAART was 260 cells/mm³ and median HIV RNA was 4.9 log₁₀ copies/mL.

·         Seven years after starting HAART the mean increase in CD4 cell count was  398, 392, 380, 278, and 184 cells/mm³ in those with baseline CD4 count <50, 50 to 200, 201 to 350, 351 to 500, and ≥500 cells/mm³, respectively.

·         The proportion of patients who spent at least 6.5 years on HAART regimens during the first 7 years after the start of HAART was significantly higher in those with lower baseline CD4 cell count:  82%, 84%, 74%, 58%, and 58%, respectively.

·         Lower CD4 cell count and higher HIV RNA level at the start of HAART, Dutch origin, transmission through intravenous drug use and a longer cumulative time on HAART were associated with greater increases in CD4 cell count after 7 years.

·         In 505 continuously HAART-treated patients, the mean annual CD4 cell count change declined significantly with longer follow-up and was 70 cells/mm³ between 1 and 3 years, 30 between 3 and 5, and 10 between 5 and 7 years.

·         The mean annual change between 5 and 7 years was significantly smaller for those with baseline CD4 cell count ≥500 cells/mm³ compared with <500 cells/mm³.

Based on these results, the authors conclude, “Greater CD4 cell count changes were associated with a longer cumulative time on HAART containing regimens.”

“Between 5 and 7 years on continuous HAART, mean CD4 cell count continued to increase except in patients with ≥500 CD4 cells/mm³ at the start of HAART.”

03/07/06

Reference
L Gras and others (for the ATHENA Cohort). Predictors for Changes in CD4 Cell Count 7 Years after Starting HAART. 13^th CROI. February 5-8, 2006. Denver, CO. Abstract 530.