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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 ; 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 
 JAIDS - Journal of Acquired Immune Dediciency Syndromes, Vol.69(3) : e85~e92, 2015 
Journal Title
 JAIDS - 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. 연구논문 > 1. College of Medicine > Dept. of Internal Medicine
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