Safety of monitoring antiretroviral therapy response in HIV-1 infection using CD4+ T cell count at long-term intervals.

Ingridt Hildegard Vogler,Daniela Frizon Alfieri,Heloisa Damazio Bruna Gianjacomo,Elaine Regina Delicato De Almeida,Edna Maria Vissoci Reiche

doi:10.1590/0102-311x00009618

Ingridt Hildegard Vogler, Daniela Frizon Alfieri + Show 3 more

Open Access

https://doi.org/10.1590/0102-311x00009618

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Abstract

The latest Brazilian guideline recommended the reduction of routine CD4+ T cell counts for the monitoring of patients with human immunodeficiency virus type 1 (HIV-1) under combination antiretroviral therapy (cART). The aim of this study was to evaluate the safety of monitoring response to cART in HIV-1 infection using routine viral load at shorter intervals and CD4+ T cell count at longer intervals. CD4+ T cell counts and HIV-1 viral load were evaluated in 1,906 HIV-1-infected patients under cART during a three-year follow-up. Patients were stratified as sustained, non-sustained and non-responders. The proportion of patients who showed a CD4+ T > 350cells/µL at study entry among those with sustained, non-sustained and non-responders to cART and who remained with values above this threshold during follow-up was 94.1%, 81.8% and 71.9%, respectively. HIV-1-infected patients who are sustained virologic responders and have initial CD4+ T cell counts > 350cells/µL showed a higher chance of maintaining the counts of these cells above this threshold during follow-up than those presenting CD4+ T ≤ 350cells/µL (OR = 39.9; 95%CI: 26.5-60.2; p < 0.001). This study showed that HIV-1-infected patients who had sustained virologic response and initial CD4+ T > 350cells/µL were more likely to maintain CD4+ T cell counts above this threshold during the next three-year follow-up. This result underscores that the evaluation of CD4+ T cell counts in longer intervals does not impair the safety of monitoring cART response when routine viral load assessment is performed in HIV-1-infected patients with sustained virologic response.

Highlights

Laboratory monitoring of patients infected with human immunodeficiency virus type 1 (HIV-1) includes CD4+ T lymphocyte counts and HIV-1 viral load (VL) quantification
In an attempt to contribute to this question, we considered performing a longitudinal study more relevant, encompassing a considerable number of individuals carefully followed from combined antiretroviral therapy (cART) onset to evaluate the safety of monitoring cART response in HIV-1 infection using routine VL at short-term intervals and CD4+ T cell count at long-term intervals
A longitudinal follow-up study was performed with outpatient HIV-1-infected individuals with medical request for CD4+ T cell and HIV-1 VL who attended at the University Hospital of Londrina, Paraná State, Brazil, from 2012 to 2015

Summary

Introduction

Laboratory monitoring of patients infected with human immunodeficiency virus type 1 (HIV-1) includes CD4+ T lymphocyte counts and HIV-1 viral load (VL) quantification. CD4+ T cell is a laboratory biomarker to assess the degree of impairment of the immune system and has been used for stratifying individuals who are candidates to start combined antiretroviral therapy (cART) and for monitoring patients over time. This biomarker has been used to indicate immunization or prophylaxis for opportunistic infections, as well as to evaluate the recovery of immune response after an adequate cART 1. We observed a certain resistance from clinicians and patients in accepting this recommendation

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