title: The future role of CD4 cell count for monitoring antiretroviral therapy.
abstract: For more than two decades, CD4 cell count measurements have been central to understanding HIV disease progression, making important clinical decisions, and monitoring the response to antiretroviral therapy (ART). In well resourced settings, the monitoring of patients on ART has been supported by routine virological monitoring. Viral load monitoring was recommended by WHO in 2013 guidelines as the preferred way to monitor people on ART, and efforts are underway to scale up access in resource-limited settings. Recent studies suggest that in situations where viral load is available and patients are virologically suppressed, long-term CD4 monitoring adds little value and stopping CD4 monitoring will have major cost savings. CD4 cell counts will continue to play an important part in initial decisions around ART initiation and clinical management, particularly for patients presenting late to care, and for treatment monitoring where viral load monitoring is restricted. However, in settings where both CD4 cell counts and viral load testing are routinely available, countries should consider reducing the frequency of CD4 cell counts or not doing routine CD4 monitoring for patients who are stable on ART.
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa. Electronic address: fordn@who.int.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.affiliation: Chelsea and Westminster Hospital, London, UK.
authors.forename: Anton
authors.initials: A
authors.lastname: Pozniak
authors.affiliation: Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa.
authors.forename: Helen
authors.initials: H
authors.lastname: Bygrave
authors.affiliation: Department of Pharmacology and Therapeutics, Liverpool University, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Trevor
authors.initials: T
authors.lastname: Peter
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.affiliation: Fundação Oswaldo Cruz, Ministry of Health, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.affiliation: YRG Centre for AIDS Research and Education, Chennai, India.
authors.forename: N
authors.initials: N
authors.lastname: Kumarasamy
authors.affiliation: Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Praphan
authors.initials: P
authors.lastname: Phanuphak
authors.affiliation: Institut de Recherche pour le Développement (IRD), Montpellier, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: deBeaudrap
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Vitoria
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Meg
authors.initials: M
authors.lastname: Doherty
authors.affiliation: Department of Molecular Medicine and Haematology, University of the Witwatersrand and National health Laboratory Services, Johannesburg, South Africa.
authors.forename: Wendy
authors.initials: W
authors.lastname: Stevens
authors.affiliation: Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, Rockville, USA.
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data*; D016903:Drug Monitoring / Q000379:methods*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans
chemical_list: D044966:Anti-Retroviral Agents