Immune restoration over 5 years on ART among patients initiating treatment with advanced immune deficiency in the DART trial in Uganda and Zimbabwe

Abstract

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/mm3, 46% 350 cells/mm3, and 19% 500 cells/mm3 (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/mm³ at week 48 was the best predictor for not reaching 250 cells/mm³ (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