1521. Risk Factors for Low Immune Recovery Among Participants with CD4+ Counts > 500 cells/mm3 who Achieved Viral Suppression in the Immediate Antiretrovrial Treatment (ART) Group in Strategic Timing of AntiRetroviral Treatment (START) Trial
Session: Poster Abstract Session: HIV: Antiretroviral Therapy
Friday, October 28, 2016
Room: Poster Hall
  • boatman_poster.pdf (2.4 MB)
  • Background: Low CD4+ recovery among individuals who initiate ART with low CD4+ counts is associated with increased risk for AIDS and non-AIDS diseases. The prevalence and risk factors for low CD4+ recovery have not been studied among individuals who begin treatment at CD4+ counts > 500 cells/mm3.

    Methods: Of the 2,326 participants in the immediate ART arm, 1,982 initiated ART within 30 days of randomization and attended the month 8 follow-up visit. Prior to randomization, participants had 2 screening CD4+ counts > 500 cells/mm3 (SC1 and SC2) within 60 days . Low CD4+ recovery was defined as a CD4+ increase < 50 cells measured from SC2 after 8 months of treatment. We used logistic regression to analyze risk factors for low CD4+ recovery for the 1,883 participants who had an HIV RNA level 200 copies/mL 8 months after initiating ART.

    Results: Among patients who achieved virologic suppression 8 months after initiating ART, the median (IQR) CD4+ cell count change at 8 months was +99 (-34.0, +236); 748(39.7%) had low CD4+ recovery. The percent of participants with low CD4 recovery was consistent across stratified levels of SC1 CD4+, ranging from 34.6% to 43.0%. In univariate analyses, race (p = 0.002), geographic location (p = 0.002), and time since diagnosis (p = 0.028) were associated with CD4+ recovery: participants who are African, black, or who were diagnosed more than 5 years before randomization had higher risk for low recovery. Lower baseline log10(RNA) (odds ratio (OR) 1.68, p < 0.001) was associated with an increased risk of low CD4+ recovery. In adjusted analyses, lower baseline log10(RNA) (OR 1.79, p < 0.001), lower SC1 CD4+ count (OR 1.07/100 cell decrease, p = 0.021), and being male (OR 1.55, p = 0.002) were significantly associated with an increased risk of poor CD4+ recovery. After 8 months of follow-up, participants with low CD4+ recovery had CD4+ counts averaging 220 cells lower (95% CI: 206.3- 233.8) than participants with high CD4+ recovery, adjusting for SC2 CD4+.

    Conclusion: Low CD4+ recovery in spite of virologic suppression is frequent even among participants starting ART at CD4+ counts > 500 cells. Similar to other studies, we confirm that lower baseline RNA is associated with an increased risk for low CD4+ recovery.

    Jeffrey Boatman, M.S., Division of Biostatistics, University of Minnesota, Minneapolis, MN, Jason Baker, MD, Infectious Diseases, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN, Sean Emery, PhD, Kirby Institute, University of New South Wales Australia, Sydney, Australia, David Mushatt, MD, MPH & TM, FIDSA, Tulane University School of Medicine, New Orleans, LA, Hansjakob Furrer, M.D., Bern University Hospital, University of Bern, Bern, Switzerland, Dalibor Sedláček, MD., PhD., Charles University Hospital, Pilsen, Czech Republic, Jens Lundgren, MD, D.M.Sc, Professor, Chip, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark and James Neaton, PhD, Biostatistics, University of Minnesota, Minneapolis, MN


    J. Boatman, None

    J. Baker, None

    S. Emery, None

    D. Mushatt, None

    H. Furrer, None

    D. Sedláček, None

    J. Lundgren, None

    J. Neaton, None

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