title: Effects of CD4 Cell Counts and Viral Load Testing on Mortality Rates in Patients With HIV Infection Receiving Antiretroviral Treatment: An Observational Cohort Study in Rural Southwest China.
abstract: Recent studies have suggested that CD4 cell count monitoring has little added value in patients who are virologically suppressed and immunologically stable if viral load (VL) testing is routinely available. These conclusions have not been directly assessed using mortality rate as a study end point in a real-world setting.
  
  
  
  This human immunodeficiency virus (HIV) treatment cohort study from 2008 to 2014 was conducted in Guangxi, China. We used a Cox regression model to analyze associations between the frequency of CD4 cell counts and VL testing and death.
  
  
  
  Compared with monitoring CD4 cell counts ≥3 times during the first year of antiretroviral therapy (ART) initiation, as currently suggested by the Chinese National Free Antiretroviral Treatment Program, monitoring them less than twice during the first year of ART was significantly associated with death; however, monitoring them twice in that year did not significantly increase mortality rates. Compared with testing VL at least once during the first year of ART, as currently suggested by the National Free Antiretroviral Treatment Program, performing no VL tests in the first year after ART initiation was significantly associated with higher mortality rates. Routine CD4 cell count monitoring did not have an impact on mortality rates among HIV-infected patients with VLs <1000 copies/mL or CD4 cell counts ≥350/μL beyond 12 months after ART initiation.
  
  
  
  Our study suggests that CD4 cell counts can be reduced to twice during the first year of ART and be reduced or stopped for patients who have achieved virologic suppression or immunologic stability after 12 months of treatment.
authors.affiliation: Guangxi Center for Disease Control and Prevention, Nanning.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Shen
authors.affiliation: Guangxi Center for Disease Control and Prevention, Nanning.
authors.forename: Qiuying
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: Guangxi Center for Disease Control and Prevention, Nanning.
authors.forename: Zhenzhu
authors.initials: Z
authors.lastname: Tang
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Pan
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Guangxi Center for Disease Control and Prevention, Nanning.
authors.forename: He
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Guangxi Center for Disease Control and Prevention, Nanning.
authors.forename: Yi
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Guangxi Center for Disease Control and Prevention, Nanning.
authors.forename: Guanghua
authors.initials: G
authors.lastname: Lan
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Xing
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Lingjie
authors.initials: L
authors.lastname: Liao
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Feng
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Shao
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data*; D002681:China; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality / Q000821:virology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019562:Viral Load / Q000706:statistics & numerical data*
chemical_list: D044966:Anti-Retroviral Agents
keywords: ART; CD4 cell count; China; HIV; viral load