Early postseroconversion CD4 cell counts independently predict CD4 cell count recovery in HIV-1-postive subjects receiving antiretroviral therapy

Background: The relationship between CD4⁺ T-cell counts determined soon after seroconversion with HIV-1 (baseline CD4⁺), nadir CD4⁺, and CD4⁺ levels attained during highly active antiretroviral therapy (HAART) is unknown. Methods: Longitudinal, including baseline (at or soon after HIV diagnosis), intermediate (nadir), and distal (post-HAART) CD4⁺ T-cell counts were assessed in 1085 seroconverting subjects who achieved viral load suppression from a large well-characterized cohort. The association of baseline with post-HAART CD4⁺ T-cell count was determined after adjustment for other relevant covariates. RESULTS:: A higher baseline CD4⁺ T-cell count predicted a greater post-HAART CD4⁺ T-cell count, independent of the nadir and other explanatory variables. Together, baseline and nadir strongly predicted the post-HAART CD4⁺ count such that a high baseline and lower nadir were associated with a maximal immune recovery after HAART. Likelihood of recovery of the baseline count after HAART was significantly higher when the nadir/baseline count ratio was consistently 0.6. Conclusions: Among viral load suppressing seroconverters, the absolute CD4⁺ T-cell count attained post-HAART is highly dependent on both baseline and nadir CD4⁺ T-cell counts. These associations further support the early diagnosis and initiation of HAART among HIV-infected persons.