Josefin Nilsson[1], Olof Elvstam[2],[3], Erik Sörstedt[4], Jan Vesterbacka[5],[6], Piotr Nowak[5],[6], Christina Carlander[5],[6]

Affiliates

[1]School of Global Public Health, New York University, New York, USA [2]Department of Translational Medicine, Lund University, Malmö [3]Department of Infectious Diseases, Växjö Central Hospital, Växjö [4]Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg [5]Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden [6]Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet

Abstract

Background

It is still uncertain why some people living with HIV (PLWH) have insufficient recovery of their CD4 cell count despite sustained HIV viral suppression. The aim of this study was to investigate factors associated with poor CD4 cell count recovery among PLWH who had a nadir CD4≤200 cells/μL prior to antiretroviral therapy (ART) with maintained HIV viral suppression.

Methods

PLWH that had initiated ART between 1996-2019 with a pre-ART nadir CD4≤200 cells/μL and had sustained viral suppression (viral levels <50 copies/mL after 6 months of treatment and continued for the next 18 months) were identified from the National HIV Registry (InfCareHIV) and included in the study population. Participants were observed for a total of 24 months beginning at the initiation of ART. Blips were permitted as independent viral measurements between 50-200 copies/mL during the observation period. CD4 cell recovery was defined as an increase of 100 cells/μL at the 2 year follow up from the baseline CD4 count at time of ART initiation. Factors associated with CD4 recovery were studied using multivariable logistic regression with 95% confidence intervals (CI).

Results

Of the 1378 PLWH included, the prevalence of immune non-response (INR) was 13%. Sex, age, baseline CD4 and baseline HIV RNA were all statistically significantly associated with CD4 recovery. Male sex was associated with 58% decreased odds of recovery (adjusted OR: 0.417, 95% CI: 0.269-0.645). Each year of increased age was associated with 3% decreased odds of recovery (adjusted OR: 0.971, 95% CI: 0.953-0. 988). Per increased baseline CD4 count (within the range 0-200 cells/μL) was associated with 1% decreased odds of recovery (adjusted OR: 0.994, 95% CI: 0.992-0.996). A higher (log) baseline HIV RNA level was associated with 15% increased odds of recovery (adjusted OR: 1.15, 95% CI: 1.06-1.25).

Conclusions

This study reinforces findings in earlier studies that male sex and older age are associated with decreased odds of immunological recovery. Higher baseline CD4 count, within the 0-200 cells/μL range, was also associated with decreased odds of recovery in this study population. In addition, we found that higher baseline HIV RNA levels were associated with increased odds of CD4 recovery. Further studies are warranted to understand the mechanism behind poor immunological recovery among those with low nadir CD4 measurements and possible mitigating methods.