Antiretroviral Therapy

Virologic Outcomes Are “Excellent” Among Patients who Initiate ART With High CD4 Cell Counts

Individuals who have CD4 cell counts of 500 cells/µL or greater when initiating antiretroviral therapy (ART) have very good virologic outcomes, according to results of a new study. In fact, these individuals were found to have better virologic suppression and reduced virologic failure than individuals who initiated ART with CD4 cell counts from 200 to 499 cells/µL.

To compare virologic outcomes by pre-ART CD4 cell count among adults with HIV, the researchers analyzed data from the HIV Prevention Trials Network 071 (PopART) trial in South Africa. The adults had initiated ART at facilities providing universal ART since January 2014, prior to routine national and international implementation.

Virologic suppression was defined as having fewer than 400 copies/mL, and confirmed virologic failure was defined as having two consecutive viral loads greater than 1000 copies/mL. These outcomes, as well as viral rebound, were compared among the 1901 participants.

At all 6-month intervals to 30 months, patients with a baseline CD4 cell count of 500 cells/µL or greater had virologic suppression of 94% or more.  

Between months 18 and 30, patients with a baseline CD4 cell count of 500 cells/µL or greater had an independently lower risk of elevated viral load (≥400 copies/mL) than patients with a CD4 cell count of 200 to 499 cells/µL (3.3% vs 9.2%).

The incidence rates of virologic failure were as follows:

  • 7.0 per 100 person-years among participants with a baseline CD4 cell count less than 200 cells/µL
  • 2.0 per 100 person-years among participants with a baseline CD4 cell count from 200 to 499 cells/µL
  • 0.5 per 100 person-years among participants with a baseline CD4 cell count 500 cells/µL or greater

Virologic failure was independently lower among participants with a baseline CD4 cell count of 500 cells/µL or greater and was 3-fold higher among those with a baseline CD4 cell count less than 200 cells/µL.

Viral rebound was equivalent between those with baseline CD4 cell counts of 500 cells/µL or greater vs from 200 to 499 cells/µL.

“These findings provide support for and are encouraging for universal ART implementation in Africa,” the researchers concluded. “Expansion of programs targeting early ART initiation are important to reach the [Joint United Nations Programme on HIV/AIDS] UNAIDS second and third ‘90-90-90’ elements of ART coverage and [virologic suppression].”

—Colleen Murphy

Reference:

Fatti G, Grimwood A, Nachega JB, et al; HIV Prevention Trials Network 071 (PopART) Study Team. Better virological outcomes among people living with human immunodeficiency virus (HIV) initiating early antiretroviral treatment (CD4 Counts ≥500 Cells/µL) in the HIV Prevention Trials Network 071 (PopART) Trial in South Africa. Clin Infect Dis. 2020;70(3):395-403. https://doi.org/10.1093/cid/ciz214.