When to monitor CD4 cell count and HIV RNA to reduce mortality and aids-defining illness in virologically suppressed hiv-positive persons on antiretroviral therapy in high-income countries: A prospective observational study

Ellen C. Caniglia, Caroline Sabin, James M. Robins, Roger Logan, Lauren E. Cain, Sophie Abgrall, Michael J. Mugavero, Sonia Hernandez-DIaz, Laurence Meyer, Remonie Seng, Daniel R. Drozd, George R. Seage, Fabrice Bonnet, Francois Dabis, Richard R. Moore, Peter Reiss, Ard Van Sighem, William C. Mathews, Julia Del Amo, Santiago MorenoSteven G. Deeks, Roberto Muga, Stephen L. Boswell, Elena Ferrer, Joseph J. Eron, Sonia Napravnik, Sophie Jose, Andrew Phillips, Ashley Olson, Amy C. Justice, Janet P. Tate, Heiner C. Bucher, Matthias Egger, Giota Touloumi, Jonathan A. Sterne, Dominique Costagliola, Michael Saag, Miguel A. Hernán

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART). Design: Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems. Methods: Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 6 1 months, (2) 6 6 1 months, and (3) 9-12 6 1 months. We used inverseprobability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes. Results: In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA .200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were 25.3 (218.6 to 7.9) and 231.7 (252.0 to 211.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies. Conclusions: Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.

Original languageEnglish (US)
Pages (from-to)214-221
Number of pages8
JournalJournal of acquired immune deficiency syndromes
Volume72
Issue number2
DOIs
StatePublished - Jun 1 2016

Keywords

  • CD4 cell count
  • HIV
  • HIV RNA
  • Monitoring
  • Mortality
  • Observational studies

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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