Abstract and Introduction
Abstract
The drug had minimal effect on the low CD4-cell counts of immunologic nonresponders.
Introduction
Most HIV-infected patients with adequate virologic suppression on antiretroviral therapy (ART) will eventually achieve a near-normal CD4-cell count. However, in 15 to 20 percent of patients, the CD4-cell count fails to rise despite full virologic suppression. Studies have linked this poor immunologic response to a heightened risk for both HIV-related and non–HIV-related disease.
Hoping to provoke an increase in CD4-cell count among immunologic nonresponders, researchers added maraviroc to the regimens of 32 patients who had undetectable viral loads for a median of 3 years but persistently low CD4-cell counts (median, 153 cells/mm3). Most of the patients were white men, and the median age was 50. Coreceptor status was assessed in 18 patients (CCR5-tropic virus in 11, dual-tropic in 5, and CXCR4-tropic in 2). Patients were treated with maraviroc for 24 weeks and then followed for another 24 weeks after drug discontinuation.
During maraviroc treatment, CD4 counts rose by a median of 12 cells/mm3; only two patients sustained CD4 count increases ≥50 cells/mm3. After maraviroc was stopped, CD4 counts continued to rise modestly, by a median of 7 cells/mm3. CD8 counts rose by about 60 cells/mm3 with maraviroc but fell toward baseline after the drug was stopped. The frequency of activated CD4 and CD8 cells decreased slightly with maraviroc, and markers of apoptosis improved, but these changes reversed when the drug was discontinued.
AIDS Clinical Care © 2012 Massachusetts Medical Society
