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Drop in CD4(+) Counts Below 200 Cells/mu L After Reaching (or Starting From) Values Higher than 350 Cells/mu L in HIV-Infected Patients With Virological Suppression

Gianotti, N; Marchetti, G; Antinori, A; Saracino, A; Gori, A; Rizzardini, G; Lichtner, M; ... Cozzi-Lepri, A; + view all (2017) Drop in CD4(+) Counts Below 200 Cells/mu L After Reaching (or Starting From) Values Higher than 350 Cells/mu L in HIV-Infected Patients With Virological Suppression. JAIDS: Journal of Acquired Immune Deficiency Syndromes , 76 (4) pp. 417-422. 10.1097/QAI.0000000000001522. Green open access

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Abstract

BACKGROUND: The aim of the study was to quantify the risk of a drop in CD4+ counts below 200 cells/μL after reaching values >350 cells/μL on antiretroviral therapy (ART) (or after starting ART with CD4+ count >350 cells/μL) in the absence of virological failure. SETTING: Ambulatory care services, Italy. METHODS: Prospective cohort study of patients enrolled in the ICONA Foundation Study cohort who started ART with >350 CD4+/μL or with ≤350 CD4+/μL and reached values >350 cells/μL after virological suppression (VS, defined by 2 consecutive viral loads ≤50 copies/mL). The date of CD4 count >350 was the baseline for the analysis and those with ≥1 viral load and CD4+ count after baseline were included. The primary end point was the cumulative risk (estimated using the Kaplan–Meier method) of a CD4+ drop below 200 cells/μL over follow-up, which was censored at the date of virological failure (confirmed HIV-RNA >50 copies/mL), death, or last visit. RESULTS: Six thousand six hundred sixty-three patients were included. A confirmed CD4+ drop below 200 cells/μL was never observed over a median follow-up of 45 (Q1: 21, Q3: 89) months, as long as VS was maintained. Upper limits of the 97.5% confidence interval of rates of confirmed CD4+ drop below 200 cells/μL were 0.28 and 0.38/1000 person-years of follow-up for patients with ≤350 and >350 CD4+ cells/μL at starting ART. CONCLUSIONS: In patients who started ART in Italy with >350 CD4+ cells/μL or reached >350 CD4+ cells/μL after VS, the risk of a CD4+ drop below 200 cells/μL in those maintaining VS was negligible.

Type: Article
Title: Drop in CD4(+) Counts Below 200 Cells/mu L After Reaching (or Starting From) Values Higher than 350 Cells/mu L in HIV-Infected Patients With Virological Suppression
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAI.0000000000001522
Publisher version: http://dx.doi.org/10.1097/QAI.0000000000001522
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, CD4(+) cells count, CD4(+) count dipping, CD4(+) count monitoring, virological suppression, antiretroviral therapy, antiretroviral therapy, observational cohort, mortality, individuals, guidelines, safe
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10044430
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