Absolute count and percentage of CD4+ lymphocytes are independent predictors of disease progression in HIV-infected persons initiating highly active antiretroviral therapy.

Hulgan T, Shepherd BE, Raffanti SP, Fusco JS, Beckerman R, Barkanic G, Sterling TR
J Infect Dis. 2007 195 (3): 425-31

PMID: 17205482 · DOI:10.1086/510536

BACKGROUND - Highly active antiretroviral therapy (HAART) is recommended when the absolute CD4(+) T lymphocyte count is <200 cells/mm(3), and it should be considered when that count is > or =200, although the optimal timing when it is > or =200 is unclear. Because preliminary data had suggested that a low CD4(+) T lymphocyte percentage (%CD4) is associated with disease progression in persons initiating HAART who have a higher absolute CD4, we sought to further characterize the predictive utility of %CD4.

METHODS - We conducted an observational study of persons in Collaborations in HIV Outcomes Research/US cohort who initiated their first HAART regimen between 1997 and 2004, received > or =30 days of therapy, and had baseline values of absolute CD4, %CD4, and HIV-1 RNA. Cox proportional-hazards models determined associations between %CD4 and disease progression (to either a new AIDS-defining event [ADE] or death).

RESULTS - Of 1891 persons, 11% were female and 18% were African American; the median age was 38 years. Median follow-up was 55 months (interquartile range, 23-83 months), and 468 (25%) had disease progression. Multivariable analysis including age, race, sex, HIV-1 RNA, prior antiretroviral therapy, probable route of infection, prior ADE, absolute CD4, and %CD4 was performed; prior ART (P<.0001), injection-drug use (P=.04), lower absolute CD4 (P=.002), and lower %CD4 (P=.002) predicted disease progression.

CONCLUSIONS - %CD4 at initiation of the first HAART regimen predicted disease progression independent of absolute CD4; %CD4 may be used to determine the timing of HAART.

MeSH Terms (22)

Adolescent Adult Aged Aged, 80 and over Anti-Retroviral Agents Antiretroviral Therapy, Highly Active Biomarkers CD4 Lymphocyte Count Cohort Studies Disease Progression Female HIV-1 HIV Infections Humans Male Middle Aged Observation Proportional Hazards Models RNA, Viral Time Factors Treatment Outcome United States

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