dynamics of cd4 in virally suppressed patients
DESCRIPTION
- PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Dynamics of CD4 in virally suppressed patients](https://reader035.vdocuments.us/reader035/viewer/2022062315/56815aaa550346895dc841f3/html5/thumbnails/1.jpg)
Is it safe to drop CD4 monitoring among virologically suppressed
patients?A cohort evaluation from Khayelitsha,
South Africa
Nathan Ford (1), Kathryn Stinson (2,3), Mary-Ann Davies (3), Vivian Cox (2), Gem Patten (2), Carol Cragg (4), Gilles Van Cutsem (2,3), Andrew Boulle (3)
1. Department of HIV/AIDS, World Health Organization, Geneva, Switzerland2. Médecins Sans Frontières
3. Centre for Infectious Disease Epidemiology and Research, University of Cape Town4. Western Cape Department of Health, Cape Town, South Africa.
![Page 2: Dynamics of CD4 in virally suppressed patients](https://reader035.vdocuments.us/reader035/viewer/2022062315/56815aaa550346895dc841f3/html5/thumbnails/2.jpg)
Dynamics of CD4 in virally suppressed patients
Hill A, IAS 2013; Gale et al CID 2013
If VL <200 copies/mL and CD4 >300 cells/uL, 97% probability of CD4 >
200 cells/uL for 4 years
![Page 3: Dynamics of CD4 in virally suppressed patients](https://reader035.vdocuments.us/reader035/viewer/2022062315/56815aaa550346895dc841f3/html5/thumbnails/3.jpg)
Methods
Setting
- Khayelitsha township, Western Cape of South Africa
- High rate of TB/HIV co-infection (67%)
- Prospective ART cohort (11 clinics)
- Routine viral load and CD4 (6 months)
- AZT+3TC+EFV up to 2004; AZT replaced by d4T then TDF
Inclusions
- All adult patients (≥16 years) initiating ART from 2001 to 2012 who achieved VL
<400 copies and CD4>200 cells/μl
- At least one subsequent paired measurement (<1 month)
Population
- 5697 patients, 34 years (IQR 20-40)
- Median baseline CD4: 63 cells/μl (2001) to 225 cells/μl (2012)
![Page 4: Dynamics of CD4 in virally suppressed patients](https://reader035.vdocuments.us/reader035/viewer/2022062315/56815aaa550346895dc841f3/html5/thumbnails/4.jpg)
Results
>90% of suppressed patients maintained CD4+ cell counts >200 cells/µl up to 10 years
97% (133/137) of CD4 declines <200 cells/µl were transient
![Page 5: Dynamics of CD4 in virally suppressed patients](https://reader035.vdocuments.us/reader035/viewer/2022062315/56815aaa550346895dc841f3/html5/thumbnails/5.jpg)
Conclusions
• These data are consistent with findings from trial and observational studies in Western settings that CD4 measures rarely change in virologically suppressed patients
• CD4 remains a critical diagnostic tool for risk stratification and ART and prophylaxis decisions
• In settings where both CD4 and viral load are available, countries could consider reducing or eliminating CD4 for monitoring