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Intern. AIDS Soc."],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Up to 30% of individuals treated with antiretroviral therapy (ART) during chronic HIV fail to recover CD4 counts to &gt;500\u00a0cells\/mm<jats:sup>3<\/jats:sup> despite plasma viral suppression. We investigated the frequency and associations of suboptimal CD4 recovery after ART started during acute HIV infection (AHI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants who started ART in Fiebig I to V AHI with \u226548\u00a0weeks of continuous documented HIV\u2010RNA\u00a0&lt;\u00a050 copies\/mL were stratified by CD4 count at latest study visit to suboptimal immune recovery (SIR; CD4\u00a0&lt;\u00a0350\u00a0cells\/mm<jats:sup>3<\/jats:sup>), intermediate immune recovery (IIR; 350\u00a0\u2264\u00a0CD4\u00a0&lt;\u00a0500) and complete immune recovery (CIR; CD4\u00a0\u2265\u00a0500). Clinical and laboratory parameters were assessed at pre\u2010ART baseline and latest study visit. Additional inflammatory and neurobehavioral endpoints were examined at baseline and 96\u00a0weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 304 participants (96% male, median 26\u00a0years old) evaluated after median 144 (range 60 to 420) weeks of ART initiated at median 19\u00a0days (range 1 to 62) post\u2010exposure, 3.6% (n\u00a0=\u00a011) had SIR and 14.5% (n\u00a0=\u00a044) had IIR. Pre\u2010ART CD4 count in SIR compared to CIR participants was 265 versus 411 cells\/mm<jats:sup>3<\/jats:sup> (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.002). Individuals with SIR or IIR had a slower CD4 rate of recovery compared to those with CIR. Timing of ART initiation by Fiebig stage did not affect CD4 count during treatment. Following ART, the CD8<jats:sup>+<\/jats:sup>T cell count (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.001) and CD4\/CD8 ratio (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.047) were lower in SIR compared to CIR participants. Compared to the CIR group at week 96, the combined SIR and IIR groups had higher sCD14 (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.008) and lower IL\u20106 (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.04) in plasma, without differences in neuropsychological or psychiatric indices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite immediate and sustained treatment in AHI, suboptimal CD4 recovery occurs uncommonly and is associated with low pre\u2010ART CD4 count as well as persistent low CD8 count and CD4\/CD8 ratio during treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25585","type":"journal-article","created":{"date-parts":[[2020,9,19]],"date-time":"2020-09-19T08:30:17Z","timestamp":1600504217000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Determinants of suboptimal CD4<sup>+<\/sup> T cell recovery after antiretroviral therapy initiation in a prospective cohort of acute HIV\u20101 infection"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8796-8238","authenticated-orcid":false,"given":"Ryan","family":"Handoko","sequence":"first","affiliation":[{"name":"Yale School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3931-5926","authenticated-orcid":false,"given":"Donn J","family":"Colby","sequence":"additional","affiliation":[{"name":"SEARCH The Thai Red Cross AIDS Research Centre Bangkok Thailand"},{"name":"United States Military HIV Research Program Walter Reed Army Institute of Research Silver Spring MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eug\u00e8ne","family":"Kroon","sequence":"additional","affiliation":[{"name":"SEARCH The Thai Red Cross AIDS Research Centre Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Sacdalan","sequence":"additional","affiliation":[{"name":"SEARCH The Thai Red Cross AIDS Research Centre Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"de Souza","sequence":"additional","affiliation":[{"name":"SEARCH The Thai Red Cross AIDS Research Centre Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suteeraporn","family":"Pinyakorn","sequence":"additional","affiliation":[{"name":"SEARCH The Thai Red Cross AIDS Research Centre Bangkok Thailand"},{"name":"United States Military HIV Research Program Walter Reed Army Institute of Research Silver Spring MD USA"},{"name":"The Henry M. 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