CD4 lymphocyte percentage predicts disease progression in HIV-infected patients initiating highly active antiretroviral therapy with CD4 lymphocyte counts >350 lymphocytes/mm3.

Hulgan T, Raffanti S, Kheshti A, Blackwell RB, Rebeiro PF, Barkanic G, Ritz B, Sterling TR
J Infect Dis. 2005 192 (6): 950-7

PMID: 16107946 · DOI:10.1086/432955

BACKGROUND - The optimal timing of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected patients with > or = 200 absolute CD4 lymphocytes/mm3 is unknown. CD4 lymphocyte percentage could add prognostic information.

METHODS - Persons who initiated HAART between 1 January 1998 and 1 January 2003, received > or = 30 days of therapy, and had baseline CD4 lymphocyte data available were included in the study. The log-rank test for time to event and Cox proportional hazards models were used to determine predictors of a new acquired immunodeficiency syndrome-defining illness or death.

RESULTS - A total of 788 patients met the inclusion criteria. At baseline, subjects had a median of 225 CD4 lymphocytes/mm3 and 17% CD4 lymphocytes. Subjects with < 17% CD4 lymphocytes had earlier disease progression, compared with subjects with > or = 17%, both in the entire cohort (P<.0001) and of those subjects with > 350 absolute CD4 lymphocytes/mm3 at baseline (P=.03). CD4 lymphocyte percentage < 17% was the strongest predictor of disease progression among subjects in this latter group (hazard ratio, 3.57; P=.045).

CONCLUSIONS - In this cohort, CD4 lymphocyte percentage predicted disease progression in HIV-infected subjects who initiated therapy with > 350 CD4 lymphocytes/mm3. This information may help identify persons who will derive the greatest benefit from initiation of HAART.

MeSH Terms (17)

Adolescent Adult Aged Antiretroviral Therapy, Highly Active CD4 Lymphocyte Count CD4-Positive T-Lymphocytes Cohort Studies Disease Progression Female HIV Infections Humans Lymphocyte Count Male Middle Aged Prognosis Proportional Hazards Models Survival Analysis

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