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Safe Reduction in CD4 Cell Count Monitoring in Stable, Virally Suppressed Patients With HIV Infection or
David Nicolás1, Anna Esteve2, Anna Cuadros3
1Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona.
Insights
Annual CD4 monitoring may be safe for HIV-monoinfected patients with counts >300 cells/µL. HIV/HCV-coinfected patients with counts >350 cells/µL also appear to tolerate annual monitoring safely.
Area of Science:
- Infectious Diseases
- Immunology
- Hepatology
Background:
- Routine CD4 monitoring frequency is debated for human immunodeficiency virus (HIV)-monoinfected patients with suppressed viral loads.
- HIV/hepatitis C virus (HCV) coinfection is common, but monitoring guidelines for this group are less defined.
- Evidence is needed to determine if reduced CD4 monitoring is safe for coinfected patients.
Purpose of the Study:
- To assess the safety of reducing CD4 cell count monitoring frequency in HIV-monoinfected and HIV/HCV-coinfected patients.
- To estimate the probability of maintaining CD4 cell counts ≥200 cells/µL during continuous HIV suppression in both patient groups.
- To provide data-driven recommendations for optimizing patient monitoring strategies.
Main Methods:
- Analysis of data from the PISCIS Cohort study (n=8695) including patients with at least 6 months of continuous HIV suppression.
- Kaplan-Meier estimator used to calculate cumulative probabilities of maintaining CD4 counts ≥200 cells/µL.
- Stratification by initial CD4 cell count at the start of the suppression period.
Main Results:
- CD4 counts fell below 200 cells/µL in 7.4% of all patients; this was lower (1.8%) for those starting with >350 cells/µL.
- Monoinfected patients experienced a drop to <200 cells/µL in 5.7%, compared to 11.1% in coinfected patients.
- 95.6% of monoinfected patients with initial CD4 counts of 300-349 cells/µL maintained counts ≥200 cells/µL; this was 97.6% for coinfected patients with initial counts >350 cells/µL.
Conclusions:
- Annual CD4 cell count monitoring is likely safe for HIV-monoinfected patients with baseline CD4 counts >300 cells/µL.
- Annual monitoring may also be safe for HIV/HCV-coinfected patients with baseline CD4 counts >350 cells/µL.
- Findings support tailored, less frequent monitoring in specific patient subgroups to optimize resource allocation.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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