Immune restoration over 5 years on ART among patients initiating treatment with advanced immune deficiency in the DART trial in Uganda and Zimbabwe.
3316 HIV-infected patients with advanced immune deficiency were treated with first-line antiretroviral therapy and, with the exception of about 5% lost to follow-up, their CD4 lymphocyte counts were measured every 12 weeks for a median follow-up period of 4.8 years. 69% ever achieved a CD4 cell count of at least 250 cells/mm<sup>3</sup>, 46% 350 cells/mm<sup>3</sup>, and 19% 500 cells/mm<sup>3</sup> (i.e. the figure whch has been suggested as a goal for effective therapy). The median time taken to achieve each of these figures was 1.8, 3.9 and >6 years, respectively. It was found that having a CD4 count of less than 125 cells/mm<sup>3</sup> at week 48 was the best predictor for not reaching 250 cells/mm<sup>3</sup> (a level above which the death rate was less than 1 per 100 person-years and the rate of WHO stage 4 clinical events was correspondingly low), and suggested that it could be an inicator of the need to swtch to second-line therapy. It is concluded that these data highlight the importance of expanded earlier diagnosis and initiation of treatment at higher CD4 counts.
Presentation from 17th Conference on Retroviruses and Opportunistic Infections, San Francisco, California, USA, 16-19 February 2010. Abstract Z-116.