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Effects of CD4 Monitoring Frequency on Clinical End Points in Clinically Stable HIV-Infected Patients With Viral Suppression

Authors
 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 
Citation
 JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, Vol.69(3) : 85-92, 2015 
Journal Title
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
ISSN
 1525-4135 
Issue Date
2015
MeSH
Adult ; Anti-HIV Agents/administration & dosage* ; Anti-HIV Agents/pharmacology ; Anti-HIV Agents/therapeutic use ; CD4 Lymphocyte Count* ; Cohort Studies ; Female ; HIV Infections/drug therapy* ; HIV Infections/immunology ; HIV Infections/virology ; HIV-1/drug effects* ; HIV-1/immunology ; Humans ; Male ; Middle Aged
Keywords
HIV infection ; HIV suppression ; CD4 count ; CD4 monitoring
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.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00126334-201507010-00013&LSLINK=80&D=ovft
DOI
10.1097/QAI.0000000000000634
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ahn, Jin Young(안진영) ORCID logo https://orcid.org/0000-0002-3740-2826
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/140994
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