Is frequent CD4+ T-lymphocyte count monitoring necessary for persons with counts >=300 cells/μL and HIV-1 suppression?

Abstract

Among patients infected with human immunodeficiency virus (HIV), those with HIV-1 RNA <200 copies/mL and CD4 counts ≥300 cells/µL had a 97.1% probability of maintaining durable CD4 ≥200 cells/µL for 4 years. When non-HIV causes of CD4 lymphopenia were excluded, the probability rose to 99.2%. Our data support less frequent CD4 monitoring during viral suppression.

Figure 1.

Patient-based Kaplan-Meier estimates (SAS, version 9.2) of probability for maintaining CD4 counts ≥200 cells/µL during continuous human immunodeficiency virus (HIV) type 1 suppression of <200 copies/mL. Results are stratified by initial CD4 count in cells per microliter. Analysis restricted to first sequence of each patient with 9 patients excluded because they only experienced CD4 counts <200 cells/µL during later sequences. A, Fifty-two patients experienced events or CD4 dips, defined as CD4 counts <200 cells/µL occurring during viral suppression. Median first sequence duration, 1.5 years (interquartile range; 0.7–3.2). Data right-censored 326 times when viral load rebounded to ≥200 copies/mL, 165 times when repeat testing not performed within 390 days, and 280 times when observation period ended 31 December 2011. B, Following exclusion of 18 patients with causes for non-HIV CD4 lymphopenia, 34 patients experienced CD4 dips. Probabilities are upper bounds because only patients who experienced CD4 dips had chart reviews. Abbreviation: HIV-1, human immunodeficiency virus type 1.