Does discordancy between the CD4 count and CD4 percentage in HIV-positive individuals influence outcomes on highly active antiretroviral therapy?

TitleDoes discordancy between the CD4 count and CD4 percentage in HIV-positive individuals influence outcomes on highly active antiretroviral therapy?
Publication TypeJournal Article
Year of Publication2012
AuthorsGompels M, Dunn D, Phillips A, Dooley D, Thomas A, Anderson J, Post F, Pillay D, Gazzard B, Hill T, Johnson M, Gilson R, Bansi L, Easterbrook P, Fisher M, Walsh J, Orkin C, Ainsworth J, Leen C and Sabin C
Corporate AuthorsUK Collaborative HIV Cohort(UK CHIC) Study(Appendix)
JournalJ Infect Dis
Volume205
Issue4
Pagination540-7
Date Published2012 Feb 15
ISSN1537-6613
KeywordsAdult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Drug Monitoring, Female, HIV Infections, Humans, Male, Middle Aged, Treatment Outcome
Abstract

INTRODUCTION: The CD4 count and CD4 percentage (CD4%) are both strong predictors of clinical disease progression in human immunodeficiency virus (HIV). Although individuals may show discordancy between their CD4 count and CD4%, the clinical relevance of this is unclear.METHODS: Discordancy was defined where the CD4% was ≤10th percentile for a selected CD4 count range (referred to as low discordancy), within the central 80% range (concordant), or ≥90th percentile (high discordancy). Regression methods identified factors associated with low and high discordancy in untreated individuals and assessed the impact of discordancy on treatment responses to highly active antiretroviral therapy (HAART).RESULTS: High discordancy was associated with female sex, low viral load, and white ethnicity; low discordancy was associated with black or nonwhite ethnicity, older age, and injection drug use. Clinical event rates were higher in individuals with high discordancy starting HAART, but there was no association with subsequent HIV progression by 6 months after starting HAART. CD4 count increases remained lower, by 20 cells/mm(3), in individuals with low discordancy, and higher, by 27 cells/mm(3), in those with high discordancy.CONCLUSIONS: Overall discrepancies between the CD4/CD4% are small, confirming the use of absolute CD4 counts as a monitoring tool.

DOI10.1093/infdis/jir380
Alternate JournalJ. Infect. Dis.
PubMed ID22279171
Grant ListMC_U122886351 / / Medical Research Council / United Kingdom
G0000199 / / Medical Research Council / United Kingdom
G0600337 / / Medical Research Council / United Kingdom