Sub-optimal CD4 recovery on long-term suppressive highly active antiretroviral therapy is associated with favourable outcome

Objectives To examine risk factors for sub-optimal CD4 recovery on suppressive highly active antiretroviral therapy (HAART) and assess long-term clinical and immunological outcomes. Methods Retrospective analysis of 286 HIV-positive patients from a university clinic who initiated HAART with CD4 count < 350 cells/mu L between January 1996 and July 2006 and achieved >= 52 weeks of viral suppression (VS). Sub-optimal and optimal CD4 count recovery were defined by gains of < 150 and >= 150 cells/mu L during the first year of VS, respectively. Risk factors were analysed by multivariate logistic regression and markers of immune maturation and activation were evaluated prospectively for a sub-group of patients with prolonged (> 5 years) VS. Results One hundred and two (36%) patients had sub-optimal CD4 recovery. Male gender, lower pre-HAART viral load, HAART toxicity and use of opportunistic infection (OI) prophylaxis were independent risk factors on multivariate analysis (P < 0.05). Outcomes of duration of VS on HAART (4 years), new OI events (1%) and mortality (5%) were similar between groups. Markers of immune maturation and activation were higher among patients with sub-optimal CD4 recovery (P < 0.05). Conclusions Among HIV-positive patients with long-term VS, sub-optimal CD4 recovery was common but morbidity and mortality remained low. In addition, persistent CD4 T-cell activation appeared to blunt long-term CD4 gains.