Is Frequent CD4⁺T-Lymphocyte Count Monitoring Necessary for Persons With Counts ≥300 Cells/µL and HIV-1 Suppression?: Figure 1.

Abstract

Among patients infected with human immunodeficiency virus (HIV), those with HIV-1 RNA <200 copies/mL and CD4 counts ≥300 cells/µL had a 97.1% probability of maintaining durable CD4 ≥200 cells/µL for 4 years. When non-HIV causes of CD4 lymphopenia were excluded, the probability rose to 99.2%. Our data support less frequent CD4 monitoring during viral suppression.

Time to reduce CD4+ monitoring for the management of antiretroviral therapy in HIV-infected individuals

“…[10] Similar studies among adults in Uganda [11] and children in SA [12] have confirmed that the CD4 + cell count does not decline significantly in the vast majority of patients who respond to treatment and are virologically suppressed. Reflecting this growing evidence base, the WHO released a technical document in March 2014 summarising the considerations in support of a move towards stopping routine CD4 + monitoring where VL monitoring is available.…”

The future role of CD4 cell count for monitoring antiretroviral therapy

“…17 A cohort study from the USA noted that of 832 patients followed for a median of 7·7 years, patients with an initial CD4 count of 300 cells per μL or more who were virologically suppressed (<200 copies/mL) had a probability of a durable CD4 count of 200 cells per μL or more at year 5 of 99·2% (95% CI 97·4-99·7), after exclusion of non-HIV causes of lymphopenia. 16 Two studies from the UK support these fi ndings. In the fi rst study, 166 patients who were stable (CD4 >500 cells per μL and virologically suppressed [<50 copies/mL]) were followed for a median of 47 weeks; only fi ve (3%) patients had a reduction in CD4 count less than 350 cells per μL and these reductions were again transient, with all CD4 measures greater than 350 cells per μL at subsequent visit.…”

“…Several studies have recently suggested that CD4 cell count monitoring has little added value in situations where viral load is available and patients are virologically suppressed. [16][17][18] In September, 2013, WHO held an expert consultation on the future role of CD4 testing for ART monitoring. We summarise the evidence and experience shared and the conclusions reached at this consultation.…”

CD4 measurement in a 54-year-old man with sustained HIV-1 viral suppression

“…4 Additionally, a retrospective cohort study involving 1820 patients with 25 463 paired viral load-CD4 measurements showed that patients who maintained virologic suppression (< 200 copies/ mL) had a 97.1% probability of maintaining a CD4 count of 200 cells/µL or greater for four years. 5 When non-HIV-related causes of decline in CD4 count were excluded, this probability increased to 99.2%. 5 Therefore, the decline in this patient's CD4 count is likely of no immediate or long-term clinical importance.…”

“…5 When non-HIV-related causes of decline in CD4 count were excluded, this probability increased to 99.2%. 5 Therefore, the decline in this patient's CD4 count is likely of no immediate or long-term clinical importance.…”