{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:35:41Z","timestamp":1790807741236,"version":"4.1.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gilead Sciences Hellas","award":["9339 - Asklepios Grants"],"award-info":[{"award-number":["9339 - Asklepios Grants"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Clinical disadvantages of initiating ART at low CD4 counts have been clearly demonstrated but whether any excess risk remains even after reaching relatively high\/safe CD4 levels remains unclear. We explore whether individuals starting ART with &lt;500 CD4 cells\/\u03bcL who increased their CD4 count above this level, have, from this point onwards, similar risk of clinical progression to serious AIDS\/non-AIDS events or death with individuals starting ART with \u2265500 CD4 cells\/\u03bcL.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data were derived from a multicenter cohort (AMACS). Adults, starting PI, NNRTI or INSTI based ART, in or after 2000 were eligible, provided they started ART with \u2265500 (\u201cHigh CD4\u201d) or started with CD4 &lt;500 cells\/\u03bcL but surpassed this threshold while on ART (\u201cLow CD4\u201d). Baseline was the date of ART initiation (\u201cHigh CD4\u201d) or of first reaching 500 CD4 cells\/\u03bcL (\u201cLow CD4\u201d). Survival analysis, allowing for competing risks, was used to explore the risk of progression to study\u2019s endpoints.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The study included 694 persons in the \u201cHigh CD4\u201d and 3,306 in the \u201cLow CD4\u201d group. Median (IQR) follow-up was 66 (36, 106) months. In total, 257 events (40 AIDS related, 217 SNAEs) were observed. Rates of progression did not differ significantly between the two groups but the subgroup of those initiating ART with &lt;200 CD4 cells\/\u03bcL had significantly higher risk of progression after baseline, compared to those in the \u201cHigh CD4\u201d group.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Individuals starting ART with &lt;200 cells\/\u03bcL remain on increased risk even after reaching 500 CD4 cells\/\u03bcL. These patients should be closely followed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0283648","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T17:31:25Z","timestamp":1680197485000},"page":"e0283648","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Low pre-ART CD4 count is associated with increased risk of clinical progression or death even after reaching 500 CD4 cells\/\u03bcL on ART"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4196-5066","authenticated-orcid":true,"given":"Nikos","family":"Pantazis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios","family":"Paparizos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios","family":"Papastamopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simeon","family":"Metallidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Antoniadou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Adamis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Psichgiou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Chini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Sambatakou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Chrysos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos V.","family":"Sipsas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalambos","family":"Gogos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil","family":"Barbunakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Periklis","family":"Panagopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Katsarou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5951-0844","authenticated-orcid":true,"given":"Giota","family":"Touloumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Athens Multicenter AIDS Cohort Study (AMACS)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,30]]},"reference":[{"issue":"11","key":"pone.0283648.ref001","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1056\/NEJM199709113371101","article-title":"A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. 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