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The Swiss HIV Cohort Study

Gilbert R. Kaufmann, MD; Luc Perrin, MD; Guiseppe Pantaleo, MD; Milos Opravil, MD; Hansjakob Furrer, MD; Amalio Telenti, MD; Bernard Hirschel, MD; Bruno Ledergerber, PhD; Pietro Vernazza, MD; Enos Bernasconi, MD; Martin Rickenbach, PhD; Matthias Egger, MD; Manuel Battegay, MD; for the Swiss HIV Cohort Study Group

Arch Intern Med. 2003;163:2187-2195.

Background  Highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV)-1 infection allows recovery of CD4 T lymphocytes. Few studies have explored the long-term T-lymphocyte responses to HAART.

Methods  Plasma HIV-1 RNA levels and CD4 and CD8 T-lymphocyte counts were longitudinally analyzed over 4 years in 2235 participants of the Swiss HIV Cohort, commencing HAART between 1996 and 1997. The CD4 T-lymphocyte count increase, the percentage of individuals with a CD4 T-lymphocyte count of 500/µL or greater and less than 200/µL, and the determinants of CD4 T-lymphocyte recovery were evaluated in individuals treated with continuous (CONT; n = 985) and discontinuous (DISCONT; n = 1250) HAART.

Results  At 4 years, 69.5% of subjects (CONT, 84.5%; DISCONT, 53.6%; P<.001) showed HIV-1 RNA levels below 400 copies/mL, while the median CD4 T-lymphocyte count increased from 190/µL to 423/µL (CONT, 486/µL; DISCONT, 343/µL; P<.001). Of the 2235 participants, 38.8% (CONT, 47.7%; DISCONT, 29.4%; P<.001) reached a CD4 T-lymphocyte count of 500/µL or greater, but in 15.6%, CD4 T-lymphocyte count remained below 200/µL (CONT, 5.9%; DISCONT, 25.9%; P<.001). Larger increases in CD4 T-lymphocyte count were associated with higher baseline HIV-1 RNA, a larger percentage of undetectable HIV-1 RNA levels, lower baseline CD8 T-lymphocyte count, and younger age. Individuals reaching a CD4 T-lymphocyte count of 500/µL or greater at 4 years were characterized by higher nadir and baseline CD4 T-lymphocyte counts and a more sustained reduction of HIV-1 RNA levels.

Conclusions  At 4 years, only 39% of individuals treated with HAART reached a CD4 T-lymphocyte count of 500/µL or greater, and 16% with CD4 T-lymphocyte counts less than 200/µL remained susceptible to opportunistic infections. Treatment interruptions, a poor virologic response, and older age were the major factors negatively affecting the recovery of CD4 T lymphocytes.

From the Basel Center for HIV Research, Division of Infectious Diseases, University Hospital, Basel, Switzerland (Drs Kaufmann and Battegay); Laboratory of Virology, University Hospital, Geneva, Switzerland (Drs Perrin and Hirschel); Laboratory of AIDS Immunopathogenesis, Department of Internal Medicine, Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois (Dr Pantaleo) and Coordination and Data Center of the Swiss HIV Cohort Study (Dr Rickenbach), University of Lausanne, Lausanne, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, Switzerland (Drs Opravil and Ledergerber); Division of Infectious Diseases, University Hospital, Berne, Switzerland (Dr Furrer); Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne (Dr Telenti); Department of Internal Medicine, Cantonal Hospital, St Gallen, Switzerland (Dr Vernazza); Department of Internal Medicine, Regional Hospital, Lugano, Switzerland (Dr Bernasconi); and Department of Social and Preventive Medicine, University of Berne, Berne (Dr Egger). The authors have no relevant financial interest in this article.

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