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

Post Date: 
2014-11-15
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Countries: 
Publication: 
AIDS Patient Care and STDs
Summary: 
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.
Citation: 
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
Collaborators: 
  • 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