title: Is CD4 monitoring needed among ugandan clients achieving a virologic and immunologic response to treatment?
abstract: 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.
authors.affiliation: 1 Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda, Maryland.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Sempa
authors.forename: Agnes N
authors.initials: AN
authors.lastname: Kiragga
authors.forename: Kevin
authors.initials: K
authors.lastname: Newell
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigozi
authors.forename: Ronald
authors.initials: R
authors.lastname: Galiwango
authors.forename: Ron
authors.initials: R
authors.lastname: Gray
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Larry
authors.initials: L
authors.lastname: Chang
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D015497:HIV-1; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016896:Treatment Outcome; D014454:Uganda; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents