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

TREAT Asia HIV Observational Databases (TAHOD)

Research output: Contribution to journalArticle

13 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)e85-e92
JournalJournal of Acquired Immune Deficiency Syndromes
Volume69
Issue number3
DOIs
Publication statusPublished - 2015 Jul 1

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HIV
CD4 Lymphocyte Count
Physiologic Monitoring
Viral Load
HIV Infections
Guidelines
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

@article{47c5e094b99f43f0bb9330c9695d80d3,
title = "Effects of CD4 Monitoring Frequency on Clinical End Points in Clinically Stable HIV-Infected Patients with Viral Suppression",
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.",
author = "{TREAT Asia HIV Observational Databases (TAHOD)} and Ahn, {Jin Young} and David Boettiger and Matthew Law and Nagalingeswaran Kumarasamy and Evy Yunihastuti and Romanee Chaiwarith and Lee, {Man Po} and Sim, {Benedict L.H.} and Shinichi Oka and Wingwai Wong and Adeeba Kamarulzaman and Pacharee Kantipong and Praphan Phanuphak and Ng, {Oon Tek} and Sasisopin Kiertiburanakul and Fujie Zhang and Sanjay Pujari and Rossana Ditangco and Winai Ratanasuwan and Merati, {Tuti Parwati} and Vonthanak Saphonn and Sohn, {Annette H.} and JunYong Choi",
year = "2015",
month = "7",
day = "1",
doi = "10.1097/QAI.0000000000000634",
language = "English",
volume = "69",
pages = "e85--e92",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

Effects of CD4 Monitoring Frequency on Clinical End Points in Clinically Stable HIV-Infected Patients with Viral Suppression. / TREAT Asia HIV Observational Databases (TAHOD).

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 69, No. 3, 01.07.2015, p. e85-e92.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effects of CD4 Monitoring Frequency on Clinical End Points in Clinically Stable HIV-Infected Patients with Viral Suppression

AU - TREAT Asia HIV Observational Databases (TAHOD)

AU - Ahn, Jin Young

AU - Boettiger, David

AU - Law, Matthew

AU - Kumarasamy, Nagalingeswaran

AU - Yunihastuti, Evy

AU - Chaiwarith, Romanee

AU - Lee, Man Po

AU - Sim, Benedict L.H.

AU - Oka, Shinichi

AU - Wong, Wingwai

AU - Kamarulzaman, Adeeba

AU - Kantipong, Pacharee

AU - Phanuphak, Praphan

AU - Ng, Oon Tek

AU - Kiertiburanakul, Sasisopin

AU - Zhang, Fujie

AU - Pujari, Sanjay

AU - Ditangco, Rossana

AU - Ratanasuwan, Winai

AU - Merati, Tuti Parwati

AU - Saphonn, Vonthanak

AU - Sohn, Annette H.

AU - Choi, JunYong

PY - 2015/7/1

Y1 - 2015/7/1

N2 - 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.

AB - 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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U2 - 10.1097/QAI.0000000000000634

DO - 10.1097/QAI.0000000000000634

M3 - Article

VL - 69

SP - e85-e92

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 3

ER -