TY - JOUR
TI - 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
AU - Caniglia, Ellen C.
AU - Sabin, Caroline
AU - Robins, James M.
AU - Logan,
AU - Roger
AU - Cain, Lauren E.
AU - Abgrall, Sophie
AU - Mugavero, Michael J.
AU - and Hernandez-Diaz, Sonia
AU - Meyer, Laurence
AU - Seng, Remonie and
AU - Drozd, Daniel R.
AU - Seage, III, George R.
AU - Bonnet, Fabrice and
AU - Dabis, Francois
AU - Moore, Richard R.
AU - Reiss, Peter
AU - van Sighem,
AU - Ard
AU - Mathews, William C.
AU - del Amo, Julia
AU - Moreno, Santiago and
AU - Deeks, Steven G.
AU - Muga, Roberto
AU - Boswell, Stephen L.
AU - Ferrer,
AU - Elena
AU - Eron, Joseph J.
AU - Napravnik, Sonia
AU - Jose, Sophie and
AU - Phillips, Andrew
AU - Olson, Ashley
AU - Justice, Amy C.
AU - Tate, Janet
AU - P.
AU - Bucher, Heiner C.
AU - Egger, Matthias
AU - Touloumi, Giota and
AU - Sterne, Jonathan A.
AU - Costagliola, Dominique
AU - Saag, Michael and
AU - Hernan, Miguel A.
AU - Ctr AIDS Res Network Integrated
JO - JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
PY - 2016
VL - 72
TODO - 2
SP - 214-221
PB - Lippincott, Williams & Wilkins
SN - null
TODO - 10.1097/QAI.0000000000000956
TODO - HIV; CD4 cell count; HIV RNA; monitoring; observational studies;
mortality
TODO - 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.
ER -