title: Rate of CD4 Decline and Factors Associated with Rapid CD4 Decline in Asymptomatic HIV-Infected Patients.
abstract: The accurate marker to assess the risk of disease progression in HIV disease is CD4 count. CD4 decline to <200 cells/mm3 prompts the patients to have risk of opportunistic infections. A retrospective cohort study was conducted in asymptomatic HIV-infected patients who had CD4 count>200 cell/mm3, were antiretroviral naive, and had ≥1-year follow-up. Eighty patients, with mean age of 36.4 (standard deviation [SD]=9.1) years and 58.8% females, were analyzed. The mean (SD) baseline CD4 count was 423 (119) cells/mm3. During the median (IQR) time of 29.0 (14.1-49.6) months, 26.3% had CD4 declined to <200 cells/mm3. From Cox proportional hazard model, only baseline CD4 count<350 cells/mm3 was significantly associated with rapid decline in CD4 count (HR 4.208; 95%CI, 1.428-12.397; P=.009). Age, gender, comorbid disease, risk of HIV infection, duration of HIV diagnosis, and body weight were not associated with rapid CD4 decline. This indicates that asymptomatic patients with CD4 count<350 cells/mm3 are at priority for antiretroviral therapy in resource-limited settings.
authors.affiliation: Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Natdanai
authors.initials: N
authors.lastname: Chaiyasin
authors.affiliation: Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand somnuek.sun@mahidol.ac.th.
authors.forename: Somnuek
authors.initials: S
authors.lastname: Sungkanuparph
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D058070:Asymptomatic Diseases / Q000401:mortality / Q000628:therapy; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: CD4 decline; asymptomatic HIV; resource-limited settings; risk factor