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Poor CD4 response despite viral suppression is associated with increased non-AIDS-related mortality among HIV

Marie Helleberg1, Gitte Kronborg, Carsten S Larsen

  • 1aDepartment of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet bFaculty of Health Sciences, Copenhagen University, Copenhagen cDepartment of Infectious Diseases, Copenhagen University Hospital, Hvidovre dDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus eDepartment of Infectious Diseases, Aalborg University Hospital, Aalborg fDepartment of Infectious Diseases, Odense University Hospital, Odense, Denmark.

AIDS (London, England)
|December 1, 2012
PubMed

Insights

Poor CD4 immune recovery after highly active antiretroviral therapy (HAART) in HIV patients is linked to higher mortality. This poor response also impacts their parents' mortality, suggesting potential genetic influences on health outcomes.

Area of Science:

  • Immunology
  • Public Health
  • Genetics

Background:

  • Poor CD4+ T-cell recovery following highly active antiretroviral therapy (HAART) is a known predictor of increased mortality in HIV patients.
  • Understanding the factors influencing CD4+ T-cell response is crucial for improving long-term outcomes in individuals with HIV.

Purpose of the Study:

  • To investigate the impact of CD4+ T-cell increase after HAART on non-AIDS-related morbidity and overall mortality in HIV patients.
  • To examine the association between HIV patients' CD4+ T-cell response and the mortality rates of their parents.

Main Methods:

  • Mortality rates were analyzed in 1758 virally suppressed HIV patients and 1603 of their parents using data from the Danish HIV Cohort Study.
  • Analyses stratified by pre-HAART CD4+ T-cell count and CD4+ T-cell increase, utilizing Poisson regression to estimate incidence rate ratios (IRRs) and mortality rate ratios (MRRs).

Main Results:

  • A CD4+ T-cell increase of less than 25 cells/μl was significantly associated with increased mortality (MRR 3.5), even in patients with pre-HAART CD4+ counts above 250 cells/μl (MRR 3.2).
  • Parents of HIV patients with a poor CD4+ T-cell response exhibited increased mortality (MRR 1.5).
  • A trend suggested an association between poor CD4+ response and increased risk of cardiovascular disease and cancer.

Conclusions:

  • Suboptimal CD4+ T-cell recovery post-HAART is linked to adverse prognosis, irrespective of baseline CD4+ T-cell levels.
  • The association between HIV patients' CD4+ response and parental mortality suggests potential shared genetic factors influencing immune response and health outcomes in both HIV-positive and HIV-negative individuals.
Abstract

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