Program Schedule

1569
The effects of frequency of CD4 monitoring on clinical endpoints in clinically stable HIV-infected patients with viral suppression

Session: Poster Abstract Session: HIV Treatment: Outcomes, Adherence, and Toxicities
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background:

Current treatment guidelines for HIV infection recommend CD4+ T lymphocyte (CD4) count monitoring every 6 to 12 months in patients with viral suppression. As clinically meaningful CD4 decline rarely occurs during viral suppression, routine CD4 monitoring may have a limited role in influencing care.

Methods:

Among patients in a regional HIV observational cohort in the Asia-Pacific, those with viral suppression (2 consecutive viral loads <400 copies/mL) and a baseline CD4 count ≥200 cells/µL within 390 days of viral suppression who had CD4 testing every 6 months during viral suppression were analyzed. Study endpoints were occurrence of one CD4 count <200 cells/µL (single CD4 <200), confirmed CD4 count <200 cells/µL (confirmed CD4 <200; 2 results <200 cells/µL within a 6-month period), and clinical failure (a new or recurrent WHO stage 3 or 4 illness). A comparison of time to single CD4 <200 and confirmed CD4<200 at 6- and 12- month intervals was performed.

Results:

Among 1538 patients who met the inclusion criteria, the rate of single CD4<200 was 3.45 per 100 patient-years, of confirmed CD4<200 was 0.77 per 100 patient-years, and of clinical failure was 0.57 per 100 patient-years. After 5 years of viral suppression, the cumulative probability of single CD4 <200 was 10%. The 5-year cumulative probabilities of confirmed CD4 <200 and clinical failure were lower than 10% (see Figure 1). Patients with baseline CD4 between 200-249 cells/µL were significantly more likely to experience confirmed CD4 <200 compared with patients with higher baseline CD4 (hazard ratio 55.47 [95% confidence interval (CI) 7.36 – 418.20], p<0.001 versus baseline CD4 ≥500). There was no significant difference in the time to confirmed CD4 <200 between the 6- and 12-month testing intervals (log rank = 0.335).

Conclusion:

Patients in our cohort with baseline CD4 <250 cells/µL were at greater risk of confirmed CD4 <200 during viral suppression compared with patients with higher baseline CD4. CD4 testing at 6-month intervals offered no benefit over annual testing in detecting confirmed CD4 <200. Annual CD4 monitoring in virally suppressed HIV patients with a baseline CD4 ≥250 cells/µL may be sufficient for clinical management.

Jin Young Ahn1, David Boettiger2, Matthew Law2, Nagalingswaran Kumarasamy3, Romanee Chiwarith4, Man Po Lee5, Benedict LH Sim6, Shinichi Oka7, Wingwai Wong8, Adeeba Kamarulzaman9, Pacharee Kantipong10, Praphan Phanuphak11, Oon Tek Ng12, Sasisopin Kiertiburanakul13, Fujie Zhang14, Sanjay Pujari15, Rossana Ditangco16, Winai Ratanasuwan17, Tuti Parwati Merati18, Vonthanak Saphonn19, Annette Sohn20, Jun Yong Choi1 and TREAT Asia HIV Observational Databases , (1)Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea, (2)The Kirby Institute, UNSW Australia, Sydney, Australia, (3)YRGCARE Medical Centre, VHS, Chennai, India, (4)Research Institute for Health Sciences, Chiang Mai, Thailand, (5)Queen Elizabeth Hospital, Hong Kong, China, (6)Hospital Sungai Buloh, Sungai Buloh, Malaysia, (7)National Center for Global Health and Medicine, Tokyo, Japan, (8)Taipei Veterans General Hospital, Taipei, Taiwan, (9)University Malaya Medical Centre, Kuala Lumpur, Malaysia, (10)Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand, (11)HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand, (12)Tan Tock Seng Hospital, Singapore, Singapore, (13)Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, (14)Beijing Ditan Hospital, Capital Medical University, Beijing, China, (15)Institute of Infectious Diseases, Pune, India, (16)Research Institute for Tropical Medicine, Manila, Philippines, (17)Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, (18)Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia, (19)National Center for HIV/AIDS, Dermatology & STDs, and University of Health Sciences, Phnom Penh, Cambodia, (20)TREAT Asia, amfAR - The Foundation for AIDS Research,, Bangkok, Thailand

Disclosures:

J. Y. Ahn, None

D. Boettiger, None

M. Law, None

N. Kumarasamy, None

R. Chiwarith, None

M. P. Lee, None

B. L. Sim, None

S. Oka, None

W. Wong, None

A. Kamarulzaman, None

P. Kantipong, None

P. Phanuphak, None

O. T. Ng, None

S. Kiertiburanakul, None

F. Zhang, None

S. Pujari, None

R. Ditangco, None

W. Ratanasuwan, None

T. P. Merati, None

V. Saphonn, None

A. Sohn, None

J. Y. Choi, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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