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When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Caniglia Ellen C, Sabin Caroline, Robins James M, Logan Roger, Cain Lauren E, Abgrall Sophie, Mugavero Michael J, Hernandez-Diaz Sonia, Meyer Laurence, Seng Remonie, Drozd Daniel R, Seage George R, Bonnet Fabrice, Dabis Francois, Moore Richard R, Reiss Peter, van Sighem Ard, Mathews William C, Del Amo Julia, Moreno Santiago, Deeks Steven G, Muga Roberto, Boswell Stephen L, Ferrer Elena, Eron Joseph J,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal Journal of acquired immune deficiency syndromes (1999)
Volume (Issue) 72(2)
Page(s) 214 - 21
Title of proceedings Journal of acquired immune deficiency syndromes (1999)
DOI 10.1097/qai.0000000000000956

Open Access

URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866894/
Type of Open Access Repository (Green Open Access)

Abstract

To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART). Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems. Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes. In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies. Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.
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