A Longitudinal Analysis of CD4+ T-Cell Count Dynamics in Treated HIV-Infected Individuals in the United States

Introduction Few published reports describe individual trajectories or heterogeneity in CD4+ T-cell count trends over time among virologically suppressed people living with HIV (PLWH). Methods We conducted a retrospective cohort study using administrative health claims among adults aged 18-65 years with a viral load of ≤ 200 copies/mL between January 1, 2012, and June 30, 2022. Among individuals with at least four CD4+ T-cell measurements, we described the proportion of individuals with both transient and sustained changes in cell counts of more than 30% overall. We stratified by baseline CD4+ T-cell count. Results A 30% increase or decrease from baseline was observed in 48.2% and 18.8% of individuals at a mean of 53.0 and 55.6 weeks of follow-up, respectively. Of people with a 30% decrease, 38.4% had at least two subsequent T-cell counts, and 24.3% did not return to within 30% of their baseline value. Discussion CD4+ T-cell counts continue to vary significantly after a year of suppressed viral load among people living with HIV. The proportion of PLWH with more than a 30% increase was more than twice that of those with more than a 30% decrease; a sustained decrease in CD4+ T-cell count was observed for 1.8% of the full cohort while they continued to be virally suppressed. Conclusion There is meaningful heterogeneity in CD4+ T-cell count trajectories, including significant drops while remaining virally suppressed, among PLWH with suppressed viral load that is infrequently described.