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Supplemental Digital Content is Available in the Text. Background: An increasing number of HIV-positive individuals now start antiretroviral therapy (ART) with high CD4 cell counts. We investigated whether this makes restoration of CD4 and CD8 cell counts and the CD4:CD8 ratio during virologically suppressive ART to median levels seen in HIV-uninfected individuals more likely and whether restoration depends on gender, age, and other individual characteristics. Methods: We determined median and quartile reference values for CD4 and CD8 cell counts and their ratio using cross-sectional data from 2309 HIV-negative individuals. We used longitudinal measurements of 60,997 HIV-positive individuals from the Antiretroviral Therapy Cohort Collaboration in linear mixed-effects models. Results: When baseline CD4 cell counts were higher, higher long-term CD4 cell counts and CD4:CD8 ratios were reached. Highest long-term CD4 cell counts were observed in middle-aged individuals. During the first 2 years, median CD8 cell counts converged toward median reference values. However, changes were small thereafter and long-term CD8 cell count levels were higher than median reference values. Median 8-year CD8 cell counts were higher when ART was started with <250 CD4 cells/mm3. Median CD4:CD8 trajectories did not reach median reference values, even when ART was started at 500 cells/mm3. Discussion: Starting ART with a CD4 cell count of ≥500 cells/mm3 makes reaching median reference CD4 cell counts more likely. However, median CD4:CD8 ratio trajectories remained below the median levels of HIV-negative individuals because of persisting high CD8 cell counts. To what extent these subnormal immunological responses affect specific clinical endpoints requires further investigation. [ABSTRACT FROM AUTHOR]

The article presents a study on the safety of dose reduction in patients with high plasma efavirenz and its ability to prevent toxicity-induced efavirenz discontinuations. It explores the results of the study using the human immunodefficiency virus (HIV)-positive patients with high plasma efavirenz level as subjects. It concludes that toxicity-induced continuation in patients with high efavirenz plasma concentrations can be prevented by dose reduction without compromising virological efficacy.

The article investigates CD4 cell count changes in therapy-naive patients during seven years of highly active antiretroviral therapy in an observational cohort. It shows that restoration of CD4 cell counts is feasible within seven years of HAART in most HIV-infected patients, achieving sufficient suppression of viral replication.