CD4 percentage is an independent predictor of survival in patients starting antiretroviral therapy with absolute CD4 cell counts between 200 and 350 cells/microL

HIV Med. 2006 Sep;7(6):383-8. doi: 10.1111/j.1468-1293.2006.00397.x.

Abstract

Objective: To determine the prognostic value of baseline CD4 percentage in terms of patient survival in comparison to absolute CD4 cell counts for HIV-positive patients initiating highly active antiretroviral therapy (HAART).

Methods: A population-based cohort study of 1,623 antiretroviral therapy-naïve HIV-positive individuals who initiated HAART between 1 August 1996 and 30 June 2002 was conducted. Cumulative mortality rates were estimated using Kaplan-Meier methods. Cox proportional hazards regression was used to model the effect of baseline CD4 strata and CD4 percentage strata and other prognostic variables on survival. A subgroup analysis was conducted on 417 AIDS-free subjects with baseline CD4 counts between 200 and 350 cells/microL.

Results: In multivariate models, low CD4 percentages were associated with increased risk of death [CD4%<5, relative hazard (RH)=4.46; CD4% 5-14, RH=2.43; P<0.01 for both] when compared with those subjects with an initial CD4 fraction of 15% or greater, but had less predictive value than absolute CD4 counts. In subgroup analyses where absolute CD4 strata were not associated with mortality, a baseline CD4 fraction below 15% [RH=2.71; 95% confidence interval (CI) 1.20-6.10], poor adherence to therapy and baseline viral load >100,000 HIV-1 RNA copies/mL were associated with an increased risk of death.

Conclusion: CD4 percentages below 15% are independent predictors of mortality in AIDS-free patients starting HAART, including those with CD4 counts between 200 and 350 cells/microL. CD4 percentage should be considered for inclusion in guidelines used to determine when to start therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiretroviral Therapy, Highly Active*
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes / immunology*
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / immunology*
  • HIV Infections / mortality*
  • HIV-1*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Survival Analysis