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Open Access Highly Accessed Research article

Trends in CD4 counts in HIV-infected patients with HIV viral load monitoring while on combination antiretroviral treatment: results from The TREAT Asia HIV Observational Database

Jialun Zhou1*, Thira Sirisanthana2, Sasisopin Kiertiburanakul3, Yi-Ming A Chen4, Ning Han5, Poh_Lian Lim6, Nagalingeswaran Kumarasamy7, Jun Yong Choi8, Tuti Parwati Merati9, Evy Yunihastuti10, Shinichi Oka11, Adeeba Kamarulzaman12, Praphan Phanuphak13, Christopher KC Lee14, Patrick CK Li15, Sanjay Pujari16, Vanthanak Saphonn17 and Matthew G Law1

Author Affiliations

1 National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia

2 Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand

3 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

4 Taipei Veterans General Hospital and AIDS Prevention and Research Centre, National Yang-Ming University, Taipei, Taiwan

5 Beijing Ditan Hospital, Beijing, China

6 Tan Tock Seng Hospital, Singapore

7 YRG Centre for AIDS Research and Education, Chennai, India

8 Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea

9 School of Medicine Udayana University & Sanglah Hospital, Denpasar, Bali, Indonesia

10 Working Group on AIDS Faculty of Medicine, University of Indonesia/Ciptomangunkusumo Hospital, Jakarta, Indonesia

11 International Medical Centre of Japan, Tokyo, Japan

12 University of Malaya Medical Centre, Kuala Lumpur, Malaysia

13 HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand

14 Hospital Sungai Buloh, Kuala Lumpur, Malaysia

15 Queen Elizabeth Hospital, Hong Kong, China

16 Institute of Infectious Diseases, Pune, India

17 National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia

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BMC Infectious Diseases 2010, 10:361  doi:10.1186/1471-2334-10-361

Published: 23 December 2010

Abstract

Background

The aim of this study was to examine the relationship between trends in CD4 counts (slope) and HIV viral load (VL) after initiation of combination antiretroviral treatment (cART) in Asian patients in The TREAT Asia HIV Observational Database (TAHOD).

Methods

Treatment-naive HIV-infected patients who started cART with three or more and had three or more CD4 count and HIV VL tests were included. CD4 count slopes were expressed as changes of cells per microliter per year. Predictors of CD4 count slopes from 6 months after initiation were assessed by random-effects linear regression models.

Results

A total of 1676 patients (74% male) were included. The median time on cART was 4.2 years (IQR 2.5-5.8 years). In the final model, CD4 count slope was associated with age, concurrent HIV VL and CD4 count, disease stage, hepatitis B or C co-infection, and time since cART initiation. CD4 count continues to increase with HIV VL up to 20 000 copies/mL during 6-12 months after cART initiation. However, the HIV VL has to be controlled below 5 000, 4 000 and 500 copies/mL for the CD4 count slope to remain above 20 cells/microliter per year during 12-18, 18-24, and beyond 24 months after cART initiation.

Conclusions

After cART initiation, CD4 counts continued to increase even when the concurrent HIV VL was detectable. However, HIV VL needed to be controlled at a lower level to maintain a positive CD4 count slope when cART continues. The effect on long-term outcomes through the possible development of HIV drug resistance remains uncertain.