CD4 T-cell recovery after initiation of antiretroviral therapy in a resource-limited setting: a prospective cohort analysis

BACKGROUND: CD4 cell count recovery after antiretroviral therapy (ART) initiation is associated with improved health outcomes. It is unknown how the CD4 counts of African HIV patients recover following ART initiation. METHODS: We examined CD4 cell count recovery in a large cohort of HIV-positive patients initiating ART in Uganda between 2004 and 2011. We categorized patients according to their CD4 cell count at ART initiation. All patients received CD4 cell count evaluations on a biannual basis. We used quantile regression to model the recovery of CD4 cells during ART. RESULTS: A total of 5271 patients aged 14 years or more at baseline were included. The median number of CD4 cell count measurements was 6 (interquartile range[IQR]:4-8), and vital status at censoring was known in 97.2% of individuals. Most CD4 cell count recovery occurred within the first 12 months, with marginal increases beyond 18 months and stabilization after 5 years. The strongest predictor of CD4 cell count recovery was baseline CD4 cell count. After 5 years on treatment, the median cell count was 334 cells/mm3 for patients initiating ART below 100 cells/mm3. Only those initiating ART above 200 cells/mm3 reached a 5-year median above 500 cells/mm3. Adolescents had the most robust CD4 cell count recovery with a median increase after 12 months that was 109 cells/mm3 greater than those initiating ART at age 50 or older. CONCLUSIONS: In individuals from a resource-limited setting, baseline CD4 cell count was highly predictive of the maximum CD4 cell count level achieved while on ART.