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Table 1 Published definitions of suboptimal CD4 reconstitution among patients with viral suppression

From: Sub-optimal CD4 reconstitution despite viral suppression in an urban cohort on Antiretroviral Therapy (ART) in sub-Saharan Africa: Frequency and clinical significance

Author

Cohort description

Duration of follow up

Baseline CD4 count

Median (IQR) cells/μl

ART regimen

Definition of SO-CD4

and Frequency

Clinical events among suboptimal responders versus complete responders

Lawn [5]

596 ART-naïve patients at a community HIV clinic in Cape Town, South Africa

48 weeks

97 (50–153)

2 NRTIs + 1 NNRTI

Increase < 50 cells/μl at 12 months

SO-CD4-7%

No data

Tuboi [6]

1914 ART naïve in HIV clinics in Africa, Latin America and Asia (ART-LINC)

6 months

137 (49–240)

2 NRTIs +1 NNRTI

(57.3%)

2 NRTIs + PI (29%)

Increase < 50 cells/μl at 6 months

SO-CD4-19%

No data

Tan [7]

Prospective observational cohort of 404 ART naïve patients in an HIV clinic at the University of Alabama, Birmingham, US

9 months

Mean = 214(SD 260)

2 NRTIs +1 NNRTI

(49%)

2 NRTIs + PI (40%)

Increase < 50 cells/μl at 6 months

SO-CD4-8.7%

Patients with discordant CD4 and virologic responses were 2.28 times more likely to develop opportunistic infections/death aOR 2.28(1.31–4.00)

Teixeira [10]

21 ART naïve patients attending an Immunology clinic at 2 sites in the US (Ohio and San Francisco)

12 months

170 (90–276)

No data

Increase < 100 cells/μl at 1 year

SO-CD4-57%

No data

Jevtovic [18]

Retrospective study of 446 patients at an HIV center in the Institute for Tropical diseases, Belgrade

52% ART naïve

33 months

Mean 115 ± 95

2 NRTIs + PI (34%)

2 NRTIs+1 NNRTI

(40%)

Absolute CD4 count of < 400 cells/μl at 2–3 years

SO-CD4-39%

Clinical events were no higher among virologic only responders than complete CD4 & virologic responders

Florence [12]

EuroSida study – Prospective cohort of 8500 ART naïve patients in 63 hospitals of 20 European countries;

12 months

150 (80–228);

2 NRTIs + PI (86%)

2NRTIs +NNRTI (10.8%)

Increase < 50 cells/μl at 6 months

SO-CD4-29%

No data

Piketty [3]

Prospective cohort of I62 ART experienced but PI -naive patients at an HIV clinic in France

12 months

Mean 69 ± 5.0

2 NRTIs + PI

Increase < 50 cells at 12 months

SO-CD4-10.5%

Higher Incidence of AIDS-defining events among virologic only responders (4/7) than complete responders (7/92) [P = 0.07]

Grabar [4]

Prospective cohort of 2236 PI naïve patients from 68 hospitals in France

18 months

150(65–263)

2NRTIs +PI

Increase < 50 cells/μl at 6 months

SO-CD4-17.3%

Patients with only good virologic responses were 3 times more likely to develop an AIDS-defining illness/death than complete responders RR 3.38 (2.28–5.02)

Kaufmann [13]

Swiss cohort study – 293 ART naïve patients

5 years

180 (60–311)

2NRTIs +PI (98%)

Absolute CD4 count below 500 cells/μl at 5 yrs

SO-CD4-35.8%

Higher incidence of CD4 category B events among incomplete responders (13.3%) than incomplete responders (9.6%) p > 0.05