Web of Science: 7 cites, Scopus: 8 cites, Google Scholar: cites,
Comparing dynamic monitoring strategies based on evolving CD4 cell counts in virologically suppressed HIV-positive individuals on cART : a prospective observational study in high-income countries
Caniglia, Ellen, C. (Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.)
Cain, Lauren E.
Sabin, Caroline A.
Robins, James M.
Logan, Roger
Abgrall, Sophie
Mugavero, Michael J.
Hernández-Díaz, Sonia
Meyer, Laurence
Seng, Remonie
Drozd, Daniel R.
Seage, George R.
Dabis, Francois
Fabrice, Bonnet
Richard, D Moore
Reiss, Peter
van Sighem, Ard
Mathews, William C.
Del Amo, Julia
Moreno, Santiago
Deeks, Steven G.
Muga, Roberto (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Boswell, Stephen L.
Ferrer, Elena
Eron, Joseph J.
Napravnik, Sonia
Jose, Sophie
Phillips, Andrew
Justice, Amy C
Tate, Janet P.
Gill, John
Pacheco, Antonio
Veloso, Valdilea G
Bucher, Heiner C
Egger, Matthias
Furrer, Hansjakob
Kholoud, Porter
Touloumi, Giota
Crane, Heidi
Miró, Jose M.
Sterne, Jonathan A.
Dominique, Costagliola
Saag, Michael
Hernán, Miguel A.

Data: 2017
Resum: Clinical guidelines vary with respect to the optimal monitoring frequency of HIV-positive individuals. We compared dynamic monitoring strategies based on evolving CD4 cell counts in virologically suppressed HIV-positive individuals. We used data from prospective studies of HIV-positive individuals in Europe and the Americas in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems. We compared three monitoring strategies, which differ with respect to the CD4 cell count threshold that is used to measure CD4 cell count and HIV-RNA every 3-6 months (when below the threshold) or every 9-12 months (when above the threshold). The strategies were defined by the thresholds 200, 350, and 500 cells/μl. We estimated hazard ratios of death and of AIDS-defining illness or death, risk ratios of virologic failure, and mean differences in CD4 cell count using inverse probability weighting to adjust for baseline and time-varying confounders. 47,635 eligible individuals initiated a cART regimen between January, 2000 and November, 2015 and met the eligibility criteria for our study. During follow-up, CD4 cell count and HIV-RNA were measured on average every 4 and 3. 8 months, respectively. 464 individuals died (107 in threshold 200 strategy, 157 in threshold 350, and 200 in threshold 500) and 1,091 had AIDS-defining illnesses or died (267 in threshold 200 strategy, 365 in threshold 350, and 459 in threshold 500). Compared with threshold 500, the mortality hazard ratio (95% CI) was 1. 05 (0. 86, 1. 29) for threshold 200 and 1. 02 (0. 91, 1. 14) for threshold 350. Corresponding estimates for death or AIDS-defining illness were 1. 08 (0. 95, 1. 22) and 1. 03 (0. 96, 1. 12), respectively. The respective 24-month risk ratios (95% CI) of virologic failure (HIV-RNA>200 copies/ml) were 2. 01 (1. 17, 3. 43) and 1. 24 (0. 89, 1. 73) and 24-month mean CD4 cell count differences (95% CIs) were 0. 4 (−25. 5, 26. 3) cells/μl and −3. 5 (−16. 0, 8. 9) cells/μl. Our findings suggest that decreasing monitoring to annually when CD4 cell count>200 cells/μl compared with >500 cells/μl does not worsen the short-term clinical and immunologic outcomes of virologically suppressed HIV-positive individuals, but more frequent virologic monitoring may be necessary to decrease the risk of virologic failure. Further follow-up is needed to establish the long-term safety of these strategies.
Ajuts: Instituto de Salud Carlos III INT15-00168
Nota: Altres ajuts: This research was supported by NIH grant R01 AI073127; by NIH grant T32 AI007433 from the National Institute of Allergy and Infectious Diseases; and by the CFAR Network of Integrated Clinical SystemsCNICS, an NIH funded program (R24 AI067039) that was made possible by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Heart, Lung and Blood Institute (NHLBI). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Drets: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades. Creative Commons
Llengua: Anglès
Document: Article ; recerca ; Versió publicada
Matèria: CD4 cell count ; HIV-RNA ; Monitoring ; Mortality ; Observational studies
Publicat a: The lancet. HIV, Vol. 4 (april 2017) , p. e251-e259, ISSN 2352-3018

DOI: 10.1016/S2352-3018(17)30043-7
PMID: 28411091


18 p, 347.2 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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 Registre creat el 2018-06-04, darrera modificació el 2021-08-08



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