Thrush and fever as markers of immune competence in the era of highly active antiretroviral therapy

The presence of clinical manifestations of HIV-1 infection is one measure of immune function failure. We examined the occurrence of clinical manifestations of HIV-1 infection, in particular fever and oral thrush, before and after the initiation of highly active antiretroviral therapy (HAART). Using data collected from 645 participants in the Multicenter AIDS Cohort Study (MACS) who used HAART, 7517 person-visits from January 1992 through March 2000 were stratified by time relative to HAART initiation (≥1 year preinitiation, <1 year preinitiation, >1 year postinitiation, and ≥1 year postinitiation) and CD4⁺T cell count (≤100, 101-200, 201-350, and >350 cells/μl). Multivariate logistic regression was used to assess the relationship between HAART, CD4⁺T cell count, and each self-reported symptom (oral hairy leukoplakia, diarrhea, fever, and oral thrush). After initiation of HAART, clinical manifestations of HIV-1 infection continued to occur and, similar to patterns seen before HAART, were more likely at lower CD4⁺T cell counts than at higher (p < 0.001). Except for diarrhea, symptoms did not occur more frequently after HAART. Rather, beyond 1 year after initiation of HAART, there was less oral thrush even at the same CD4⁺T cell count. These results provide evidence that increases in CD4⁺T cell count due to HAART represent a reconstitution of immune function.