Three different patterns of CD4 recovery in a cohort of Chinese HIV patients following antiretroviral therapy - a five-year observational study

To explore the heterogeneity of CD4 responses following highly active antiretroviral therapy, the patterns of CD4 recovery of HIV-1-infected Chinese patients who have been on their first antiretroviral regimen for =5 years were analysed. The CD4 trajectories were traced, smoothed and differentiated into three defined profiles. Half (56.3 ) were `satisfactory responders?, with CD4 gain of >100 cells/?L and a peak of >350 cells/?L, plateauing before the end of Year 5. Thirty-three (24.4 ) were `continuing responders? whose CD4 rise persisted at Year 4?5. The remaining 26 (19.3 ) were `poor responders?. Presentation with AIDS before therapy was common not just among `poor? but also paradoxically the `continuing? responders. While a majority had responded well to antiretroviral therapy, older patients and those with AIDS diagnosis before initiation of therapy may never achieve a satisfactory level even with effective treatment. Categorization of HIV patients by their CD4 trajectory may support the prediction of immunological outcome over time, and ultimately inform treatment choices.