Washington D.C., USA, 22-27 July 2012www.aids2012.org

Frequent CD4 cell count monitoring is not necessary for persons with counts >300 cells/µL and HIV-1 viral suppression

H Gale,1 D Benator,1,2 F Gordin,1,2 A Labriola,1,2 H. Hoffman,2 V Kan,1,2

1Veterans Affairs Medical Center, 2The George Washington University, Washington, DC

Assess the durability of CD4 cell counts above the clinical threshold of 200 cells/µL among HIV-infected patients with viral suppression (consecutive VL <200 cells/mL).

Examined 25,500 paired VL and CD4 counts of 1821 patients, Sept. 1998 – Dec. 2011.

1363 Patients with three or more paired HIV-1 RNA (VL) and CD4 values values

846 Patients with one or more sequences Establishment requires consecutive VL / CD4 pairs with

VL <200 copies/mL CD4 counts >200 cells/µL %CD4 >14 <390 days between CD4 to assure continuity of care

and a third VL / CD4 pair within the next 390 days

[517 with no sequences were excluded]

785 maintained a CD4 count >200 cells/µL during VL suppression

61 experienced a CD4 count <200 cells/µL during VL suppression

Figure 1. Cohort distribution

Washington D.C., USA, 22-27 July 2012www.aids2012.org

CD4 dip: CD4 count <200 cells/µL during VL suppression of <200 copies/mL. Clinically associated causes at time of CD4 dip:

radiation/chemotherapy (n = 9) interferon treatment (n = 7)post-operative hospitalization (n = 3) severe infection (n = 3)viral-induced lymphopenia (n = 1) steroid-induced lymphopenia (n = 1)

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Probability of maintaining a CD4 count >200 cells/µL during viral suppression

Figure 2. Analyses were limited to first sequences. Fig. 2A includes all 53 CD4 dips as events and Fig. 2B includes only the 35 CD4 dips with no associated clinical causes as events. Sequences ended at the VL/CD4 pair just prior to a VL rebound >199 copies/mL, a testing gap >390 days, or the end of the observation period on 12/31/2011.

Conclusions• CD4 monitoring may be performed less frequently than recommended in current guidelines: measurement with every VL is not necessary once a sustained virologic suppression is achieved.• Patients who maintain viral suppression of <200 copies/mL and have a CD4 count >300

cells/µL are extremely unlikely to experience a CD4 count <200 cells/µL.

The views expressed are those of the authors and do not reflect the views or policies of the Department of Veterans Affairs. All authors report no conflict of interest.