title: CD4 changes among virologically suppressed patients on antiretroviral therapy: a systematic review and meta-analysis.
abstract: BACKGROUND
  The effectiveness of antiretroviral therapy (ART) is assessed by measuring CD4 cell counts and viral load. Recent studies have questioned the added value of routine CD4 cell count measures in patients who are virologically suppressed.
  
  
  METHODS
  We systematically searched three databases and two conference sites up to 31 October 2014 for studies reporting CD4 changes among patients who were on ART and virologically suppressed. No geographic, language or age restrictions were applied.
  
  
  CONCLUSIONS
  We identified 12 published and 1 unpublished study reporting CD4 changes among 20,297 virologically suppressed patients. The pooled proportion of patients who experienced an unexplained, confirmed CD4 decline was 0.4% (95% CI 0.2-0.6%). Results were not influenced by duration of follow-up, age, study design or region of economic development. No studies described clinical adverse events among virologically suppressed patients who experienced CD4 declines.
  
  
  CONCLUSIONS
  The findings of this review support reducing or stopping routine CD4 monitoring for patients who are immunologically stable on ART in settings where routine viral load monitoring is provided.
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; fordn@who.int.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Stinson
authors.affiliation: Veteran Affairs Medical Center, Washington, DC, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Gale
authors.affiliation: Global Evaluative Sciences, Vancouver, British Columbia, Canada.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
authors.affiliation: Department of Molecular Medicine and Haematology, National Health Laboratory Services, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Wendy
authors.initials: W
authors.lastname: Stevens
authors.affiliation: Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Pérez González
authors.forename: Mercedes P
authors.initials: MP
authors.lastname: González
authors.affiliation: Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
authors.forename: Jessica
authors.initials: J
authors.lastname: Markby
authors.affiliation: Department of Pharmacology and Therapeutics, Liverpool University, Liverpool, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: CD4; HIV; antiretroviral therapy; treatment monitoring; viral load