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Implementation and Operational Research: Effects of CD4 Monitoring Frequency on Clinical End Points in Clinically Stable HIV-Infected Patients With Viral Suppression

Title
Implementation and Operational Research: Effects of CD4 Monitoring Frequency on Clinical End Points in Clinically Stable HIV-Infected Patients With Viral Suppression
Authors
Ahn, Jin Young;Boettiger, David;Choi, Jun Yong;Sohn, Annette H.;Saphonn, Vonthanak;Merati, Tuti Parwati;Ratanasuwan, Winai;Ditangco, Rossana;Pujari, Sanjay;Zhang, Fujie;Kiertiburanakul, Sasisopin;Ng, Oon Tek;Phanuphak, Praphan;Kantipong, Pacharee;Kamarulzaman, Adeeba;Wong, Wingwai;Oka, Shinichi;Sim, Benedict L. H.;Lee, Man Po;Chaiwarith, Romanee;Yunihastuti, Evy;Kumarasamy, Nagalingeswaran;Law, Matthew
Issue Date
2015
Journal Title
JAIDS - Journal of Acquired Immune Dediciency Syndromes
ISSN
1525-4135
Citation
JAIDS - Journal of Acquired Immune Dediciency Syndromes, Vol.69(3) : e85~e92, 2015
Abstract
BACKGROUND: Current treatment guidelines for HIV infection recommend routine CD4 lymphocyte (CD4) count monitoring in patients with viral suppression. This may have a limited impact on influencing care as clinically meaningful CD4 decline rarely occurs during viral suppression. METHODS: In a regional HIV observational cohort in the Asia-Pacific region, patients with viral suppression (2 consecutive viral loads <400 copies/mL) and a CD4 count ≥200 cells per microliter who had CD4 testing 6 monthly were analyzed. Main study end points were occurrence of 1 CD4 count <200 cells per microliter (single CD4 <200) and 2 CD4 counts <200 cells per microliter within a 6-month period (confirmed CD4 <200). A comparison of time with single and confirmed CD4 <200 with biannual or annual CD4 assessment was performed by generating a hypothetical group comprising the same patients with annual CD4 testing by removing every second CD4 count. RESULTS: Among 1538 patients, the rate of single CD4 <200 was 3.45/100 patient-years and of confirmed CD4 <200 was 0.77/100 patient-years. During 5 years of viral suppression, patients with baseline CD4 200-249 cells per microliter were significantly more likely to experience confirmed CD4 <200 compared with patients with higher baseline CD4 [hazard ratio, 55.47 (95% confidence interval: 7.36 to 418.20), P < 0.001 versus baseline CD4 ≥500 cells/μL]. Cumulative probabilities of confirmed CD4 <200 was also higher in patients with baseline CD4 200-249 cells per microliter compared with patients with higher baseline CD4. There was no significant difference in time to confirmed CD4 <200 between biannual and annual CD4 measurement (P = 0.336). CONCLUSIONS: Annual CD4 monitoring in virally suppressed HIV patients with a baseline CD4 ≥250 cells per microliter may be sufficient for clinical management.
URI
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00126334-201507010-00013&LSLINK=80&D=ovft

http://ir.ymlib.yonsei.ac.kr/handle/22282913/140994
DOI
10.1097/QAI.0000000000000634
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
Yonsei Authors
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