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Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine January 2020 Cd4+ T Cell Recovery And Cerebrospinal Fluid Escape After Antiretroviral Therapy Initiation In Acute Hiv-1 Infection Ryan Christopher Handoko Follow this and additional works at: https://elischolar.library.yale.edu/ymtdl Recommended Citation Handoko, Ryan Christopher, "Cd4+ T Cell Recovery And Cerebrospinal Fluid Escape After Antiretroviral Therapy Initiation In Acute Hiv-1 Infection" (2020) Yale Medicine Thesis Digital Library 3907 https://elischolar.library.yale.edu/ymtdl/3907 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale For more information, please contact elischolar@yale.edu CD4+ T Cell Recovery and Cerebrospinal Fluid Escape After Antiretroviral Therapy Initiation in Acute HIV-1 Infection A Thesis Submitted to the Yale University School of Medicine in Partial Fulfillment of the Requirements for the Degree of Doctor in Medicine by Ryan Christopher Handoko 2020 Abstract Introduction: Up to 30% of individuals treated with antiretroviral therapy (ART) during chronic HIV fail to recover CD4 counts to >500 cells/mm3 and up to 10% have quantifiable HIV RNA in cerebrospinal fluid (CSF), termed CSF escape, despite plasma viral suppression < 50 copies/mL Previous studies have shown that ART initiation in the earliest stage of identifiable infection, acute HIV infection (prior to antibody seroconversion), may limit viral reservoir establishment and systemic immune activation and may improve clinical outcomes We investigated the frequency, associations, and outcomes of suboptimal CD4 recovery (Project 1) and CSF escape (Project 2) after ART started during acute HIV infection (AHI) Methods: Thai participants with laboratory-confirmed diagnosis of AHI (Fiebig stages I to V) were started immediately on ART and followed longitudinally with blood sampling, neuropsychological and neurobehavioral testing, and optional lumbar puncture For Project 1, participants with ≥48 weeks of documented HIV RNA 200+/mul Despite Effective HAART PLoS One 2015;10(5):e0124741 74 Engsig FN, Zangerle R, Katsarou O, Dabis F, Reiss P, Gill J, et al Long-term mortality in HIV-positive individuals virally suppressed for >3 years with incomplete CD4 recovery Clin Infect Dis 2014;58(9):1312-21 75 Kaufmann GR, Furrer H, Ledergerber B, Perrin L, Opravil M, Vernazza P, et al Characteristics, determinants, and clinical relevance of CD4 T cell recovery to
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