{"doi":"10.1093/cid/ciac249","title":"Antiretroviral Initiation at ≥800 CD4+ Cells/mm3 Associated With Lower Human Immunodeficiency Virus Reservoir Size","abstract":"BACKGROUND: Identifying factors that determine the frequency of latently infected CD4+ T cells on antiretroviral therapy (ART) may inform strategies for human immunodeficiency virus (HIV) cure. We investigated the role of CD4+ count at ART initiation for HIV persistence on ART. METHODS: Among participants of the Strategic Timing of Antiretroviral Treatment Study, we enrolled people with HIV (PWH) who initiated ART with CD4+ T-cell counts of 500-599, 600-799, or ≥ 800 cells/mm3. After 36-44 months on ART, the levels of total HIV-DNA, cell-associated unspliced HIV-RNA (CA-US HIV-RNA), and two-long terminal repeat HIV-DNA in CD4+ T cells were quantified and plasma HIV-RNA was measured by single-copy assay. We measured T-cell expression of Human Leucocyte Antigen-DR Isotype (HLA-DR), programmed death-1, and phosphorylated signal transducer and activator of transcription-5 (pSTAT5). Virological and immunological measures were compared across CD4+ strata. RESULTS: We enrolled 146 PWH, 36 in the 500-599, 60 in the 600-799, and 50 in the ≥ 800 CD4 strata. After 36-44 months of ART, total HIV-DNA, plasma HIV-RNA, and HLA-DR expression were significantly lower in PWH with CD4+ T-cell count ≥ 800 cells/mm3 at ART initiation compared with 600-799 or 500-599 cells/mm3. The median level of HIV-DNA after 36-44 months of ART was lower by 75% in participants initiating ART with ≥ 800 vs 500-599 cells/mm3 (median [interquartile range]: 16.3 [7.0-117.6] vs 68.4 [13.7-213.1] copies/million cells, respectively). Higher pSTAT5 expression significantly correlated with lower levels of HIV-DNA and CA-US HIV-RNA. Virological measures were significantly lower in females. CONCLUSIONS: Initiating ART with a CD4+ count ≥ 800 cells/mm3 compared with 600-799 or 500-599 cells/mm3 was associated with achieving a substantially smaller HIV reservoir on ART.","journal":"Clinical Infectious Diseases","year":2022,"id":272594,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9555,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":263681,"name":"Sunil K. Ahuja","orcid":"0000-0002-6001-6181","position":1,"is_corresponding":false},{"id":510720,"name":"Locadiah Kuwanda","orcid":null,"position":2,"is_corresponding":false},{"id":606003,"name":"Michael J. Vjecha","orcid":null,"position":3,"is_corresponding":false},{"id":692058,"name":"Fleur Hudson","orcid":"0000-0001-5891-7514","position":4,"is_corresponding":false},{"id":939602,"name":"Luxshimi Lal","orcid":null,"position":5,"is_corresponding":false},{"id":459501,"name":"Ajantha Rhodes","orcid":"0000-0003-3576-4732","position":6,"is_corresponding":false},{"id":350100,"name":"Judy Chang","orcid":"0000-0001-5785-3643","position":7,"is_corresponding":false},{"id":286757,"name":"Sarah Palmer","orcid":"0000-0002-9195-3805","position":8,"is_corresponding":false},{"id":939603,"name":"Paula Auberson-Munderi","orcid":null,"position":9,"is_corresponding":false},{"id":781750,"name":"Henry Mugerwa","orcid":"0000-0002-9578-5781","position":10,"is_corresponding":false},{"id":252299,"name":"Robin Wood","orcid":"0000-0002-4276-7117","position":11,"is_corresponding":false},{"id":503215,"name":"Sharlaa Badal‐Faesen","orcid":"0000-0002-7306-5732","position":12,"is_corresponding":false},{"id":596958,"name":"Sandy Pillay","orcid":null,"position":13,"is_corresponding":false},{"id":675539,"name":"Rosie Mngqibisa","orcid":"0000-0002-6540-5733","position":14,"is_corresponding":false},{"id":939604,"name":"Alberto M. LaRosa","orcid":null,"position":15,"is_corresponding":false},{"id":939605,"name":"Jose Hildago","orcid":null,"position":16,"is_corresponding":false},{"id":364615,"name":"Kathy Petoumenos","orcid":"0000-0001-7534-7154","position":17,"is_corresponding":false},{"id":690605,"name":"Chris Chiu","orcid":"0000-0002-5380-1114","position":18,"is_corresponding":false},{"id":847427,"name":"Joseph Lutaakome","orcid":null,"position":19,"is_corresponding":false},{"id":939144,"name":"Jonathan Kitonsa","orcid":"0000-0003-2467-4037","position":20,"is_corresponding":false},{"id":939606,"name":"Esther Kabaswaga","orcid":null,"position":21,"is_corresponding":false},{"id":938013,"name":"Pietro Pala","orcid":"0000-0001-5670-3774","position":22,"is_corresponding":false},{"id":470077,"name":"Carmela Ganoza","orcid":"0000-0001-6238-8504","position":23,"is_corresponding":false},{"id":714459,"name":"Katie Fisher","orcid":"0000-0002-8732-706X","position":24,"is_corresponding":false},{"id":299125,"name":"Christina C. Chang","orcid":"0000-0003-0109-0725","position":25,"is_corresponding":false},{"id":299394,"name":"Sharon R. Lewin","orcid":"0000-0002-0330-8241","position":26,"is_corresponding":false},{"id":605496,"name":"Edwina Wright","orcid":"0000-0001-8626-782X","position":27,"is_corresponding":false},{"id":522125,"name":"Thomas A. Rasmussen","orcid":"0000-0001-5354-2442","position":0,"is_corresponding":true}],"reference_count":41,"raw_metadata":null,"created_at":"2026-07-19T00:27:47.926496Z","pmid":"35396591","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}