title: Safe Reduction in CD4 Cell Count Monitoring in Stable, Virally Suppressed Patients With HIV Infection or HIV/Hepatitis C Virus Coinfection.
abstract: It has been suggested that routine CD4 cell count monitoring in human immunodeficiency virus (HIV)-monoinfected patients with suppressed viral loads and CD4 cell counts >300 cell/μL could be reduced to annual. HIV/hepatitis C virus (HCV) coinfection is frequent, but evidence supporting similar reductions in CD4 cell count monitoring is lacking for this population. We determined whether CD4 cell count monitoring could be reduced in monoinfected and coinfected patients by estimating the probability of maintaining CD4 cell counts ≥200 cells/µL during continuous HIV suppression.
  
  
  
  The PISCIS Cohort study included data from 14 539 patients aged ≥16 years from 10 hospitals in Catalonia and 2 in the Balearic Islands (Spain) since January 1998. All patients who had at least one period of 6 months of continuous HIV suppression were included in this analysis. Cumulative probabilities with 95% confidence intervals were calculated using the Kaplan-Meier estimator stratified by the initial CD4 cell count at the period of continuous suppression initiation.
  
  
  
  A total of 8695 patients were included. CD4 cell counts fell to <200 cells/µL in 7.4% patients, and the proportion was lower in patients with an initial count >350 cells/µL (1.8%) and higher in those with an initial count of 200-249 cells/µL (23.1%). CD4 cell counts fell to <200 cells/µL in 5.7% of monoinfected and 11.1% of coinfected patients. Of monoinfected patients with an initial CD4 cell count of 300-349 cells/µL, 95.6% maintained counts ≥200 cells/µL. In the coinfected group with the same initial count, this rate was lower, but 97.6% of coinfected patients with initial counts >350 cells/µL maintained counts ≥200 cells/µL.
  
  
  
  From our data, it can be inferred that CD4 cell count monitoring can be safely performed annually in HIV-monoinfected patients with CD4 cell counts >300 cells/µL and HIV/HCV-coinfected patients with counts >350 cells/µL.
authors.affiliation: Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona.
authors.forename: David
authors.initials: D
authors.lastname: Nicolás
authors.affiliation: Centre for Epidemiological Studies on HIV/STI in Catalonia - ASPC, CIBER Epidemiologia y Salud Publica.
authors.forename: Anna
authors.initials: A
authors.lastname: Esteve
authors.affiliation: University of Barcelona.
authors.forename: Anna
authors.initials: A
authors.lastname: Cuadros
authors.affiliation: Centre for Epidemiological Studies on HIV/STI in Catalonia - ASPC, CIBER Epidemiologia y Salud Publica.
authors.forename: Colin N J
authors.initials: CNJ
authors.lastname: Campbell
authors.affiliation: Fundació Lluita Contra la Sida, Fundacio Irsicaixa, Hospital Universitari Germans Trias i Pujol.
authors.forename: Cristina
authors.initials: C
authors.lastname: Tural
authors.affiliation: Hospital Universitari de Bellvitge-Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat.
authors.forename: Daniel
authors.initials: D
authors.lastname: Podzamczer
authors.affiliation: Hospital Universitario Son Espases.
authors.forename: Javier
authors.initials: J
authors.lastname: Murillas
authors.affiliation: Hospital Son Llàtzer, Palma de Mallorca.
authors.forename: Francesc
authors.initials: F
authors.lastname: Homar
authors.affiliation: Corporació Sanitària i Universitària Parc Taulí, Universitat Autónoma de Barcelona.
authors.forename: Ferrán
authors.initials: F
authors.lastname: Segura
authors.affiliation: Hospital de Mataró.
authors.forename: Lluis
authors.initials: L
authors.lastname: Force
authors.affiliation: Hospital General de Vic.
authors.forename: Josep
authors.initials: J
authors.lastname: Vilaró
authors.affiliation: Hospital de Palamós.
authors.forename: Àngels
authors.initials: À
authors.lastname: Masabeu
authors.affiliation: Hospital General d'Hospitalet, Barcelona.
authors.forename: Isabel
authors.initials: I
authors.lastname: Garcia
authors.affiliation: Hospital Alt Penedès de Vilafranca, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Mercadal
authors.affiliation: Centre for Epidemiological Studies on HIV/STI in Catalonia - ASPC, CIBER Epidemiologia y Salud Publica.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Montoliu
authors.affiliation: Hospital Universitari de Bellvitge-Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat.
authors.forename: Elena
authors.initials: E
authors.lastname: Ferrer
authors.affiliation: Hospital Universitario Son Espases.
authors.forename: Melcior
authors.initials: M
authors.lastname: Riera
authors.affiliation: Hospital Son Llàtzer, Palma de Mallorca.
authors.forename: Carmen
authors.initials: C
authors.lastname: Cifuentes
authors.affiliation: Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona.
authors.forename: Juan
authors.initials: J
authors.lastname: Ambrosioni
authors.affiliation: Corporació Sanitària i Universitària Parc Taulí, Universitat Autónoma de Barcelona.
authors.forename: Gemma
authors.initials: G
authors.lastname: Navarro
authors.affiliation: Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona.
authors.forename: Christian
authors.initials: C
authors.lastname: Manzardo
authors.affiliation: Hospital Universitari de Bellvitge-Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat.
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Clotet
authors.affiliation: Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Gatell
authors.affiliation: Centre for Epidemiological Studies on HIV/STI in Catalonia - ASPC, CIBER Epidemiologia y Salud Publica.
authors.forename: Jordi
authors.initials: J
authors.lastname: Casabona
authors.affiliation: Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona.
authors.forename: José M
authors.initials: JM
authors.lastname: Miró
authors.forename: J
authors.initials: J
authors.lastname: Murillas
authors.forename: C
authors.initials: C
authors.lastname: Manzardo
authors.forename: A
authors.initials: A
authors.lastname: Masabeu
authors.forename: J
authors.initials: J
authors.lastname: Mercadal
authors.forename: C
authors.initials: C
authors.lastname: Cifuentes
authors.forename: D
authors.initials: D
authors.lastname: Dalmau
authors.forename: P
authors.initials: P
authors.lastname: Domingo
authors.forename: V
authors.initials: V
authors.lastname: Falcó
authors.forename: A
authors.initials: A
authors.lastname: Curran
authors.forename: C
authors.initials: C
authors.lastname: Agustí
authors.forename: A
authors.initials: A
authors.lastname: Montoliu
authors.forename: I
authors.initials: I
authors.lastname: Pérez
authors.forename: Jordi
authors.initials: J
authors.lastname: Curto
authors.forename: F
authors.initials: F
authors.lastname: Gargoulas
authors.forename: A
authors.initials: A
authors.lastname: Gómez
authors.forename: J C
authors.initials: JC
authors.lastname: Rubia
authors.forename: L
authors.initials: L
authors.lastname: Zamora
authors.forename: J L
authors.initials: JL
authors.lastname: Blanco
authors.forename: F
authors.initials: F
authors.lastname: Garcia-Alcaide
authors.forename: E
authors.initials: E
authors.lastname: Martínez
authors.forename: J
authors.initials: J
authors.lastname: Mallolas
authors.forename: J M
authors.initials: JM
authors.lastname: Llibre
authors.forename: G
authors.initials: G
authors.lastname: Sirera
authors.forename: J
authors.initials: J
authors.lastname: Romeu
authors.forename: A
authors.initials: A
authors.lastname: Jou
authors.forename: E
authors.initials: E
authors.lastname: Negredo
authors.forename: M
authors.initials: M
authors.lastname: Saumoy
authors.forename: A
authors.initials: A
authors.lastname: Imaz
authors.forename: F
authors.initials: F
authors.lastname: Bolao
authors.forename: C
authors.initials: C
authors.lastname: Cabellos
authors.forename: C
authors.initials: C
authors.lastname: Peña
authors.forename: S
authors.initials: S
authors.lastname: DiYacovo
authors.forename: E
authors.initials: E
authors.lastname: Van Den Eynde
authors.forename: M
authors.initials: M
authors.lastname: Sala
authors.forename: M
authors.initials: M
authors.lastname: Cervantes
authors.forename: M J
authors.initials: MJ
authors.lastname: Amengual
authors.forename: M
authors.initials: M
authors.lastname: Navarro
authors.forename: V
authors.initials: V
authors.lastname: Segura
authors.forename: P
authors.initials: P
authors.lastname: Barrufet
authors.forename: J
authors.initials: J
authors.lastname: Molina
authors.forename: M
authors.initials: M
authors.lastname: Alvaro
authors.forename: T
authors.initials: T
authors.lastname: Payeras
authors.forename: M
authors.initials: M
authors.lastname: Gracia Mateo
authors.forename: Juanse
authors.initials: J
authors.lastname: Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D015331:Cohort Studies; D060085:Coinfection / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000276:immunology* / Q000821:virology; D015497:HIV-1; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology* / Q000276:immunology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019562:Viral Load; D055815:Young Adult
keywords: CD4 cell count; HIV-1; HIV-1 suppression; HIV-1/HCV coinfection