Routine CD4 monitoring in HIV patients with viral suppression: Is it really necessary? A Portuguese cohort

• Main Authors: Raquel Duro, Nuno Rocha-Pereira, Cristovão Figueiredo, Carmela Piñeiro, Cátia Caldas, Rosário Serrão, António Sarmento
• Format: Article
• Language: English
• Published: Elsevier 2018-10-01
• Series: Journal of Microbiology, Immunology and Infection
• Online Access: http://www.sciencedirect.com/science/article/pii/S1684118217300701

Purpose: CD4 cell-count has been regarded as the key surrogate marker for prognostic staging and therapeutic monitoring of HIV-infected individuals. Our purpose was to assess the probability of maintaining a CD4 count >200 cells/μL in patients with continuous viral suppression and CD4 cell counts >200 cells/μL. Methods: Retrospective cohort study of HIV-infected patients, treatment naïve, who started antiretroviral therapy between 2007 and 2011. We estimated the probability of maintaining CD4 counts >200 cells/μL during continuous viral suppression using the Kaplan–Meier method. The hazard ratios of a CD4 count <200 cells/μL were estimated and compared using Cox proportional hazards regression. Results: 401 patients were included: 70.1% men; median age 37 years; 98.8% HIV-1 infected. The median duration of continuous viral suppression with CD4 counts >200 cells/μL was 40.5 months. Ninety-three percent of patients maintained CD4 counts ≥200 cells/μL during the period of continuous viral suppression. Compared with those with an initial CD4 count ≥350 cells/μL, patients with initial CD4 count <300 cells/μL had a significantly higher risk of a CD4 count <200 cells/μL. Patients with viral suppression and CD4 counts ≥350 cells/μL had a 97.1% probability of maintaining CD4 cell counts ≥200 cells/μL for 48 months. Conclusions: The probability of a CD4 count <200 cells/μL in an HIV-infected patient with viral suppression and CD4 ≥350 cells/μL was very low. These data suggests less frequent monitoring of CD4 counts in these patients. Keywords: CD4 count monitoring, HIV infection, Viral suppression, CD4 counts