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