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CD4+ T-Cell Count Monitoring Does Not Accurately Identify HIV-Infected Adults With Virologic Failure Receiving Antiretroviral Therapy

Moore, David M MDCM, MHSc*†‡; Awor, Anna MSc*; Downing, Robert PhD*; Kaplan, Jonathan MD, MPH§; Montaner, Julio S G MD†‡; Hancock, John MSc*; Were, Willy MBChB, MPH*; Mermin, Jonathan MD, MPH*

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 2008 - Volume 49 - Issue 5 - p 477-484
doi: 10.1097/QAI.0b013e318186eb18
Clinical Science

Background: CD4+ T-lymphocyte (CD4) counts are widely used to monitor response to antiretroviral therapy (ART) in resource-limited settings. However, the utility of such monitoring in terms of predicting virologic response to therapy has been little studied.

Methods: We studied participants aged 18 years and older who initiated ART in Tororo, Uganda. CD4 counts, CD4 percentages, and viral load (VL) were examined at 6-monthly intervals. Various definitions of immunologic failure were examined to identify individuals with VLs ≥ 50, ≥500, ≥1000, or ≥5000 copies per milliliter at 6, 12, and 18 months after treatment initiation.

Results: One thousand sixty-three ART-naive persons initiated ART. The proportion of individuals with virologic failure ranged between 1.5% and 16.4% for each time point. The proportion with no increase in CD4 count from baseline did not differ between those with suppressed or unsuppressed VLs at 6, 18, and 24 months after ART initiation. No increase in CD4 cell counts at 6 months had a sensitivity of 0.04 [95% confidence interval (CI) 0.00 to 0.10] and a positive predictive value of 0.03 (95% CI 0.00 to 0.09) for identifying individuals with VL ≥ 500 copies per milliliter at 6 months. The best measure identified was an absolute CD4 cell count <125 cells per microliter at 21 months for predicting VL ≥ 500 copies per milliliter at 18 months which had a sensitivity of 0.13 (95% CI 0.01 to 0.21) and a positive predictive value of 0.29 (95% CI 0.10 to 0.44).

Conclusions: CD4 cell count monitoring does not accurately identify individuals with virologic failure among patients taking ART.

From the *Global AIDS Program, US Centers for Disease Control and Prevention, Entebbe, Uganda; †British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; ‡Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and §Global AIDS Program, US Centers for Disease Control and Prevention, Atlanta, GA.

Received for publication March 20, 2008; accepted July 3, 2008.

The Home-Based AIDS Care Project is funded through Centers for Disease Control and Prevention by the President's Emergency Plan for AIDS Relief.

The authors have no known conflict of interest.

The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Correspondence to: David M. Moore, MDCM, MHSc, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, British Columbia V6T 1Y6, Canada (e-mail:dmoore@cfenet.ubc.ca).

© 2008 Lippincott Williams & Wilkins, Inc.