Veterans Affairs Research Center for AIDS and HIV-1 Infection, South Texas Veterans Health Care System, San Antonio, Texas, USA.
N Engl J Med. 2013 Jan 17;368(3):218-30. doi: 10.1056/NEJMoa1110187.
The relationship between the timing of the initiation of antiretroviral therapy (ART) after infection with human immunodeficiency virus type 1 (HIV-1) and the recovery of CD4+ T-cell counts is unknown.
In a prospective, observational cohort of persons with acute or early HIV-1 infection, we determined the trajectory of CD4+ counts over a 48-month period in partially overlapping study sets: study set 1 included 384 participants during the time window in which they were not receiving ART and study set 2 included 213 participants who received ART soon after study entry or sometime thereafter and had a suppressed plasma HIV viral load. We investigated the likelihood and rate of CD4+ T-cell recovery to 900 or more cells per cubic millimeter within 48 months while the participants were receiving viral-load-suppressive ART.
Among the participants who were not receiving ART, CD4+ counts increased spontaneously, soon after HIV-1 infection, from the level at study entry (median, 495 cells per cubic millimeter; interquartile range, 383 to 622), reached a peak value (median, 763 cells per cubic millimeter; interquartile range, 573 to 987) within approximately 4 months after the estimated date of infection, and declined progressively thereafter. Recovery of CD4+ counts to 900 or more cells per cubic millimeter was seen in approximately 64% of the participants who initiated ART earlier (≤4 months after the estimated date of HIV infection) as compared with approximately 34% of participants who initiated ART later (>4 months) (P<0.001). After adjustment for whether ART was initiated when the CD4+ count was 500 or more cells per cubic millimeter or less than 500 cells per cubic millimeter, the likelihood that the count would increase to 900 or more cells per cubic millimeter was lower by 65% (odds ratio, 0.35), and the rate of recovery was slower by 56% (rate ratio, 0.44), if ART was initiated later rather than earlier. There was no association between the plasma HIV RNA level at the time of initiation of ART and CD4+ T-cell recovery.
A transient, spontaneous restoration of CD4+ T-cell counts occurs in the 4-month time window after HIV-1 infection. Initiation of ART during this period is associated with an enhanced likelihood of recovery of CD4+ counts. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
人类免疫缺陷病毒 1 型（HIV-1）感染后开始抗逆转录病毒治疗（ART）的时间与 CD4+T 细胞计数恢复之间的关系尚不清楚。
在一项急性或早期 HIV-1 感染者的前瞻性观察队列研究中，我们在部分重叠的研究组中确定了 48 个月期间 CD4+计数的轨迹：研究组 1 包括 384 名参与者，在他们未接受 ART 的时间窗口内；研究组 2 包括 213 名参与者，他们在研究入组后不久或之后接受了 ART，并且血浆 HIV 病毒载量得到抑制。我们研究了在接受病毒载量抑制性 ART 的同时，参与者在 48 个月内 CD4+T 细胞恢复到 900 个或更多细胞/立方毫米的可能性和速度。
在未接受 ART 的参与者中，CD4+计数在 HIV-1 感染后不久会自发增加，从研究入组时的水平（中位数 495 个细胞/立方毫米；四分位距 383 至 622），在估计的感染日期后约 4 个月内达到峰值（中位数 763 个细胞/立方毫米；四分位距 573 至 987），此后逐渐下降。与较晚（>4 个月）开始 ART 的参与者（约 34%）相比，较早（≤4 个月）开始 ART 的参与者中有约 64%（P<0.001）的 CD4+计数恢复到 900 个或更多细胞/立方毫米。调整 CD4+计数为 500 个或更多细胞/立方毫米或小于 500 个细胞/立方毫米时启动 ART，与较晚开始 ART 相比，计数增加到 900 个或更多细胞/立方毫米的可能性低 65%（比值比 0.35），恢复速度慢 56%（速率比 0.44）。ART 开始时的血浆 HIV RNA 水平与 CD4+T 细胞恢复无关。
HIV-1 感染后 4 个月时间窗内，CD4+T 细胞计数会出现短暂的自发恢复。在此期间开始 ART 与 CD4+计数恢复的可能性增加有关。（由美国国家过敏和传染病研究所及其他机构资助）。
