7th International AIDS Society Conference, Kuala Lumpur, June 2013:
A French study shows that people who start HIV treatment with CD4 counts above 500 had much lower HIV reservoir levels and higher CD4 counts over time than those who started below 500. Researchers followed 309 people from 2005–2012 an average of 3.7 years and grouped them according to their CD4 counts for comparison: 500 and higher, 200–499, and below 200.
CD4 counts and CD4/CD8 ratios were collected at least yearly. Viral loads were also collected from all participants, which measured the HIV DNA in peripheral blood mononuclear cells, or PBMCs. The study sought to find any difference in the amount of HIV DNA over time among the three groups as well as assess whether immune function would normalize over time.
The results showed that the higher the CD4 count over time, the lower the level of HIV DNA. The average CD4 count was highest in the 500+ group at 1,011 compared to 662 and 515 in the other 2 groups. As for average viral load, the 500+ group showed 2.51 log copies in PBMCs compared to 2.78 and 2.91 log copies in the other groups. Similarly, the CD4/CD8 ratio was also better in the 500+ group at 1.25 compared to .88 and .66 in the other groups.
Although there were not equal numbers of people in each of the three groups (30 in 500+, 155 in 200–499 and 124 in <200) and the average years of follow-up per group also varied, these results suggest that starting treatment even in people at or above 500 CD4s can benefit their long-term health.
ABSTRACT
L Hocqueloux, V Avettand-Fènoël, T Prazuck, et al. In chronically HIV-1-infected patients long-term antiretroviral therapy initiated above 500 CD4/mm3 achieves better HIV-1 reservoirs’ depletion and T-cell count restoration. 7th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, June 30-July 3, 2013.
For more detailed discussion on this topic, go to HIVandHepatitis.com.