Is CD4 monitoring needed among Ugandan clients achieving a virologic and immunologic response to treatment?

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AIDS Patient Care and STDs
It is unclear whether ongoing CD4 monitoring is needed following immunologic and virologic response to antiretroviral therapy (ART). We investigated the proportion of clients who achieved a virologic and immunologic response and then had a subsequent CD4 count <200 cells/μL despite continued virologic suppression. Included in this analysis were clients receiving ART through the Rakai Health Sciences Program between June 2004-May 2013 who achieved a CD4 ≥200 cells/μL and VL ≤400 copies/mL and who had three sets of CD4 and VL measurements (defined as a sequence) within a 390 day period. A CD4 decline was defined as any drop in CD4 count to <200 cells/μL during a period of viral suppression. A total of 1553 clients were included, 68% females, mean age of 35.5 years (SD 8.3), median baseline CD4 count 183 cells/μL (IQR 106-224). 43 (2.8%) clients developed CD4 declines, the majority, 32/43 (74%), among individuals whose initial CD4 was <300 cells/μL. Of the 43 clients with CD4 declines, 24 had an additional CD4 measurement and 20/24 (83%) achieved a CD4 ≥200 cell/μL on their next measurement (median 285 cells/μL; IQR 220-365). CD4 declines were significantly greater among those with lower CD4 at sequence initiation [adjusted hazard ratio (AHR) 4.3 (95% CI 2.1, 9.0) CD4 200-249 versus ≥350 cells/μL]. Clients who achieved an immunologic and virologic response to ART were unlikely to experience a subsequent CD4 count decline to <200 cells/μL, and among those experiencing a decline, the majority were transient in nature. Thus, ongoing CD4 monitoring could be omitted.
Reynolds SJ, Sempa JB, Kiragga AN, Newell K, Nakigozi G, Galiwango R, Gray R, Quinn TC, Serwadda D, Chang LW. Is CD4 monitoring needed among Ugandan clients achieving a virologic and immunologic response to treatment? AIDS Patient Care and STDS. 2014;18(11). PMID: 25290988
  • Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
  • Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
  • Clinical Research Directorate/CMRP, Leidos Biomedical Research, Inc. (formerly SAIC-Frederick Inc.), Frederick National Laboratory for Cancer Research, Frederick, MD
  • 5Rakai Health Sciences Program, Kalisizo, Uganda
  • Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
  • Makerere University School of Public Health, Kampala, Uganda