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
Caniglia, Ellen C. (Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA)
Sabin, Caroline A. (University College London, London, United Kingdom)
Robins, James M. (Department of Biostatistics, Harvard T.H. Chan School of Public Health)
Logan, Roger (Department of Epidemiology, Harvard T.H. Chan School of Public Health)
Cain, Lauren E. (Department of Epidemiology, Harvard T.H. Chan School of Public Health)
Abgrall, Sophie (Assistance Publique-Hopitaux de Paris (AP-HP), Hopital Antoine Béclère, Service de Médecine Interne)
Mugavero, Michael J. (University of Alabama at Birmingham)
Hernandez-Diaz, Sonia (Department of Epidemiology, Harvard T.H. Chan School of Public Health)
Meyer, Laurence (Université Paris Sud, INSERM CESP U1018, and AP-HP, Hopital de Bicêtre, Service de Santé Publique)
Seng, Remonie (Université Paris Sud, INSERM CESP U1018, and AP-HP, Hopital de Bicêtre, Service de Santé Publique)
Drozd, Daniel R. (Division of Allergy and Infectious Diseases, School of Medicine, University of Washington)
Seage, George R. (Department of Epidemiology, Harvard T.H. Chan School of Public Health)
Bonnet, Fabrice (Bordeaux University, ISPED, INSERM U897 CHU de Bordeaux)
Dabis, Francois (INSERM U897, Centre Inserm Epidémiologie et Biostatistique, Université de Bordeaux, and Department of Internal Medicine, Bordeaux University Hospital)
Moore, Richard R. (School of Medicine, Johns Hopkins University, Baltimore, MD)
Reiss, Peter (Stichting HIV Monitoring, Amsterdam, Netherlands; Academic Medical Center, Department of Global Health and Division of Infectious Diseases, University of Amsterdam, and Amsterdam Institute for Global Health and Development)
van Sighem, Ard (Stichting HIV Monitoring, Amsterdam, Netherlands)
Mathews, William C. (Internal Medicine, Johns Hopkins University)
Del Amo, Julia (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Moreno, Santiago (Instituto Ramón y Cajal de Investigación Sanitaria (Madrid))
Deeks, Steven G. (Positive Health Program, San Francisco General Hospital)
Muga, Roberto (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Boswell, Stephen L. (Fenway Health)
Ferrer, Elena (Institut d'Investigació Biomèdica de Bellvitge)
Eron, Joseph J. (Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill)
Napravnik, Sonia (Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill)
Jose, Sophie (University College London)
Phillips, Andrew (University College London, London, United Kingdom)
Olson, Ashley (Medical Research Council Clinical Trials Unit, University College London)
Justice, Amy C. (VA Connecticut Healthcare System)
Tate, Janet P. (VA Connecticut Healthcare System)
Bucher, Heiner (University Hospital Basel (Basilea, Suïssa))
Egger, Matthias (University of Bern, Institute for Social and Preventive Medicine, Bern, Switzerland)
Touloumi, Giota (Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School)
Sterne, Jonathan A. (School of Social and Community Medicine, University of Bristol)
Costagliola, Dominique (Institute Pierre Louis d'Épidémiologie et de Santé Publique)
Saag, Michael (Department of Medicine, University of Alabama at Birmingham)
Hernán, Miguel A. (Department of Medicine, University of Alabama at Birmingham)
Universitat Autònoma de Barcelona

Date:	2016
Abstract:	Supplemental Digital Content is Available in the Text. To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART). 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. 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 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes. 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 −5. 3 (−18. 6 to 7. 9) and −31. 7 (−52. 0 to −11. 3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies. 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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	HIV ; CD4 cell count ; HIV RNA ; Monitoring ; Observational studies ; Mortality
Published in:	Journal of acquired immune deficiency syndromes (1999), Vol. 72 (may 2016) , p. 214-221, ISSN 1944-7884

DOI: 10.1097/QAI.0000000000000956
PMID: 26895294

8 p, 283.7 KB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles