Low Risk of CD4 Decline After Immune Recovery in Human Immunodeficiency Virus-Infected Children With Viral Suppression

Abstract

Regular CD4 testing may be unnecessary for virally suppressed children aged 5-15 years with CD4 ≥500 cells/mm3.

Recent Trends in Adult and Pediatric Antiretroviral Therapy Monitoring and Failure

“…20 Strong evidence from the Asia-Pacific region shows that regular CD4 monitoring is unnecessary among adults and children with viral suppression on ART because of their very low risk of immune or clinical treatment failure. 1,2 It was expected that we would see a decline in CD4 monitoring over time in our analysis. However, we also expected an increase in viral load monitoring frequency.…”

“…An important goal of antiretroviral therapy (ART) is the sustained suppression of HIV. Low viral burden substantially reduces the risk of immune and clinical failure, 1,2 both advanced states of treatment failure that tend to occur after viral nonsuppression and lead to a poor clinical prognosis. [3][4][5][6][7][8] Early detection of viral proliferation allows ART adherence issues to be addressed promptly, thereby reducing the likelihood of antiretroviral resistance and retaining second-and third-line options.…”

A case for reduced frequency of CD4 count monitoring for children on combination antiretroviral therapy with consistently undetectable HIV viral load

“…We suggest that future PENTA guidelines take these data and those of previously published paediatric studies [2,3] into account and recommend annual CD4 count monitoring in virally suppressed children and young people.…”

“…Paediatric European Network for Treatment of AIDS (PENTA) guidelines currently recommend monitoring CD4 T-cell counts every 3-4 months in all children and young people with HIV infection [1]. The clinical utility of monitoring CD4 count this frequently in the context of fully suppressed HIV viral load (VL) has been questioned [2][3][4]. When available, VL is the most useful correlate of adherence and/or combination antiretroviral therapy (cART) failure.…”

“…When available, VL is the most useful correlate of adherence and/or combination antiretroviral therapy (cART) failure. Two published paediatric studies in South Africa and Asia suggest that there is a low risk of CD4 decline in virally suppressed children [2,3]. While transient drops in CD4 count do occur in virally suppressed patients, they rarely contribute to clinical decision-making [4,5].…”