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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

 Ahn, Jin Young  ;  Boettiger, David  ;  Law, Matthew  ;  Kumarasamy, Nagalingeswaran  ;  Yunihastuti, Evy  ;  Chaiwarith, Romanee  ;  Lee, Man Po  ;  Sim, Benedict L. H.  ;  Oka, Shinichi  ;  Wong, Wingwai  ;  Kamarulzaman, Adeeba  ;  Kantipong, Pacharee  ;  Phanuphak, Praphan  ;  Ng, Oon Tek  ;  Kiertiburanakul, Sasisopin  ;  Zhang, Fujie  ;  Pujari, Sanjay  ;  Ditangco, Rossana  ;  Ratanasuwan, Winai  ;  Merati, Tuti Parwati  ;  Saphonn, Vonthanak  ;  Sohn, Annette H.  ;  Choi, Jun Yong 
 Journal of Acquired Immune Dediciency Syndromes, Vol.69(3) : 85-92, 2015 
Journal Title
 Journal of Acquired Immune Dediciency Syndromes 
Issue Date
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.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
안진영(Ahn, Jin Young) ORCID logo https://orcid.org/0000-0002-3740-2826
최준용(Choi, Jun Yong) ORCID logo https://orcid.org/0000-0002-2775-3315
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