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.
Bibliographical noteFunding Information:
The TREAT Asia HIV Observational Database is part of the Asia Pacific HIV Observational Database and is an initiative of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the National Institute of Allergy and Infectious Diseases (NIAID) of the U.S. National Institutes of Health (NIH) as part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) (grant no. U01AI069907), and from the Dutch Ministry of Foreign Affairs through a partnership with Stichting Aids Fonds. The National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing, and is affiliated with the Faculty of Medicine, The University of New South Wales. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above. The TREAT Asia HIV Observational Database CV Mean, V Saphonn* and K Vohith, National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia; FJ Zhang*, HX Zhao and N Han, Beijing Ditan Hospital, Beijing, China; PCK Li* and MP Lee, Queen Elizabeth Hospital, Hong Kong, China; N Kumarasamy* and S Saghayam, YRG Centre for AIDS Research and Education, Chennai, India; S Pujari*‡ and K Joshi, Institute of Infectious Diseases, Pune, India; TP Merati* and F Yuliana, Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia; E Yunihastuti* and O Ramadian, Working Group on AIDS Faculty of Medicine, University of Indonesia/Ciptomangunkusumo Hospital, Jakarta, Indonesia; S Oka* and M Honda, International Medical Centre of Japan, Tokyo, Japan; JY Choi* and SH Han, Division of Infectious Diseases, Dept. of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; C KC Lee* and R David, Hospital Sungai Buloh, Kuala Lumpur, Malaysia; A Kamarulzaman* and A Kajindran, University of Malaya Medical Centre, Kuala Lumpur, Malaysia; G Tau, Port Moresby General Hospital, Port Moresby, Papua New Guinea**; R Ditangco* and R Capistrano, Research Institute for Tropical Medicine, Manila, Philippines; YMA Chen*, WW Wong and YW Yang, Taipei Veterans General Hospital and AIDS Prevention and Research Centre, National Yang-Ming University, Taipei, Taiwan; PL Lim*, OT Ng and E Foo, Tan Tock Seng Hospital, Singapore; P Phanuphak*, and M Khongphattanayothin, HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; S Sungkanuparph*, S Kiertiburanakul, and B Piyavong, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; T Sirisanthana*† and W Kotarathititum, Research Institute for Health Sciences, Chiang Mai, Thailand; J Chuah*, Gold Coast Sexual Health Clinic, Miami, Queensland, Australia; AH Sohn*, L Messerschmidt* and B Petersen, TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand; DA Cooper, MG Law*, J Zhou* and A Jiamsakul, National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia. * TAHOD Steering Committee member; **Inactive site; † Steering Committee Chair; ‡ co-Chair.
All Science Journal Classification (ASJC) codes
- Infectious Diseases