Ageing and long-term CD4 cell count trends in HIV-positive patients with 5 years or more combination antiretroviral therapy experience

Wright, ST; Petoumenos, K; Boyd, M; Carr, A; Downing, S; O'Connor, CC; Grotowski, M; Law, MG

Ageing and long-term CD4 cell count trends in HIV-positive patients with 5 years or more combination antiretroviral therapy experience

Wright, ST

Petoumenos, K Boyd, M Carr, A Downing, S O'Connor, CC Grotowski, M Law, MG

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Publication Type:: Journal Article
Citation:: HIV Medicine, 2013, 14 (4), pp. 208 - 216
Issue Date:: 2013-04-01

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Field	Value	Language
dc.contributor.author	Wright, ST https://orcid.org/0000-0002-8593-6056	en_US
dc.contributor.author	Petoumenos, K	en_US
dc.contributor.author	Boyd, M	en_US
dc.contributor.author	Carr, A	en_US
dc.contributor.author	Downing, S	en_US
dc.contributor.author	O'Connor, CC	en_US
dc.contributor.author	Grotowski, M	en_US
dc.contributor.author	Law, MG	en_US
dc.date.available	2012-08-22	en_US
dc.date.issued	2013-04-01	en_US
dc.identifier.citation	HIV Medicine, 2013, 14 (4), pp. 208 - 216	en_US
dc.identifier.issn	1464-2662	en_US
dc.identifier.uri	http://hdl.handle.net/10453/116335
dc.description.abstract	Objectives: The aim of this study was to describe the long-term changes in CD4 cell counts beyond 5 years of combination antiretroviral therapy (cART). If natural ageing leads to a long-term decline in the immune system via low-grade chronic immune activation/inflammation, then one might expect to see a greater or earlier decline in CD4 counts in older HIV-positive patients with increasing duration of cART. Methods: Retrospective and prospective data were examined from long-term virologically stable HIV-positive adults from the Australian HIV Observational Database. We estimated mean CD4 cell count changes following the completion of 5 years of cART using linear mixed models. Results: A total of 37916 CD4 measurements were observed for 892 patients over a combined total of 9753 patient-years. Older patients (>50 years old) at cART initiation had estimated mean (95% confidence interval) changes in CD4 counts by year-5 CD4 count strata (<500, 500-750 and >750 cells/μL) of 14 (7 to 21), 3 (-5 to 11) and -6 (-17 to 4) cells/μL/year. Of the CD4 cell count rates of change estimated, none were indicative of long-term declines in CD4 cell counts. Conclusions: Our results suggest that duration of cART and increasing age do not result in decreasing mean changes in CD4 cell counts for long-term virologically suppressed patients, indicating that the level of immune recovery achieved during the first 5 years of treatment is sustained through long-term cART. © 2012 British HIV Association.	en_US
dc.relation.ispartof	HIV Medicine	en_US
dc.relation.isbasedon	10.1111/j.1468-1293.2012.01053.x	en_US
dc.subject.classification	Virology	en_US
dc.subject.mesh	CD4-Positive T-Lymphocytes	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	HIV Infections	en_US
dc.subject.mesh	CD4 Lymphocyte Count	en_US
dc.subject.mesh	Drug Therapy, Combination	en_US
dc.subject.mesh	Antiretroviral Therapy, Highly Active	en_US
dc.subject.mesh	Linear Models	en_US
dc.subject.mesh	Retrospective Studies	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	Aging	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.title	Ageing and long-term CD4 cell count trends in HIV-positive patients with 5 years or more combination antiretroviral therapy experience	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	14	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Science
pubs.organisational-group	/University of Technology Sydney/Faculty of Science/School of Mathematical and Physical Sciences
utslib.copyright.status	closed_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	14	en_US

Abstract:

Objectives: The aim of this study was to describe the long-term changes in CD4 cell counts beyond 5 years of combination antiretroviral therapy (cART). If natural ageing leads to a long-term decline in the immune system via low-grade chronic immune activation/inflammation, then one might expect to see a greater or earlier decline in CD4 counts in older HIV-positive patients with increasing duration of cART. Methods: Retrospective and prospective data were examined from long-term virologically stable HIV-positive adults from the Australian HIV Observational Database. We estimated mean CD4 cell count changes following the completion of 5 years of cART using linear mixed models. Results: A total of 37916 CD4 measurements were observed for 892 patients over a combined total of 9753 patient-years. Older patients (>50 years old) at cART initiation had estimated mean (95% confidence interval) changes in CD4 counts by year-5 CD4 count strata (<500, 500-750 and >750 cells/μL) of 14 (7 to 21), 3 (-5 to 11) and -6 (-17 to 4) cells/μL/year. Of the CD4 cell count rates of change estimated, none were indicative of long-term declines in CD4 cell counts. Conclusions: Our results suggest that duration of cART and increasing age do not result in decreasing mean changes in CD4 cell counts for long-term virologically suppressed patients, indicating that the level of immune recovery achieved during the first 5 years of treatment is sustained through long-term cART. © 2012 British HIV Association.

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http://hdl.handle.net/10453/116335