@article{3170320,
    title = "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",
    author = "Caniglia, Ellen C. and Sabin, Caroline and Robins, James M. and Logan, and Roger and Cain, Lauren E. and Abgrall, Sophie and Mugavero, Michael J. and and Hernandez-Diaz, Sonia and Meyer, Laurence and Seng, Remonie and and Drozd, Daniel R. and Seage, III, George R. and Bonnet, Fabrice and and Dabis, Francois and Moore, Richard R. and Reiss, Peter and van Sighem, and Ard and Mathews, William C. and del Amo, Julia and Moreno, Santiago and and Deeks, Steven G. and Muga, Roberto and Boswell, Stephen L. and Ferrer, and Elena and Eron, Joseph J. and Napravnik, Sonia and Jose, Sophie and and Phillips, Andrew and Olson, Ashley and Justice, Amy C. and Tate, Janet and P. and Bucher, Heiner C. and Egger, Matthias and Touloumi, Giota and and Sterne, Jonathan A. and Costagliola, Dominique and Saag, Michael and and Hernan, Miguel A. and Ctr AIDS Res Network Integrated",
    journal = "JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES",
    year = "2016",
    volume = "72",
    number = "2",
    pages = "214-221",
    publisher = "Lippincott, Williams & Wilkins",
    doi = "10.1097/QAI.0000000000000956",
    keywords = "HIV; CD4 cell count; HIV RNA; monitoring; observational studies;
mortality",
    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 +/- 1 months, (2) 6 +/- 1 months, and (3)
9-12 +/- 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 (-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.
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."
}