When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study.

Caniglia, Ellen CEllen CCanigliaSabin, CarolineCarolineSabinRobins, James MJames MRobinsLogan, RogerRogerLoganCain, Lauren ELauren ECainAbgrall, SophieSophieAbgrallMugavero, Michael JMichael JMugaveroHernandez-Diaz, SoniaSoniaHernandez-DiazMeyer, LaurenceLaurenceMeyerSeng, RemonieRemonieSengDrozd, Daniel RDaniel RDrozdSeage, George RGeorge RSeageBonnet, FabriceFabriceBonnetDabis, FrancoisFrancoisDabisMoore, Richard RRichard RMooreReiss, PeterPeterReissvan Sighem, ArdArdvan SighemMathews, William CWilliam CMathewsDel Amo, JuliaJuliaDel AmoMoreno, SantiagoSantiagoMorenoDeeks, Steven GSteven GDeeksMuga, RobertoRobertoMugaBoswell, Stephen LStephen LBoswellFerrer, ElenaElenaFerrerEron, Joseph JJoseph JEronNapravnik, SoniaSoniaNapravnikJose, SophieSophieJosePhillips, AndrewAndrewPhillipsOlson, AshleyAshleyOlsonJustice, Amy CAmy CJusticeTate, Janet PJanet PTateBucher, Heiner CHeiner CBucherEgger, MatthiasMatthiasEgger0000-0001-7462-5132Touloumi, GiotaGiotaTouloumiSterne, Jonathan AJonathan ASterneCostagliola, DominiqueDominiqueCostagliolaSaag, MichaelMichaelSaagHernán, Miguel AMiguel AHernán2024-10-242024-10-242016-06-01https://boris-portal.unibe.ch/handle/20.500.12422/142588OBJECTIVE To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART). DESIGN Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems. METHODS Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes. RESULTS In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies. CONCLUSIONS Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.en600 - Technology::610 - Medicine & health300 - Social sciences, sociology & anthropology::360 - Social problems & social servicesWhen to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study.article10.7892/boris.836322689529410.1097/QAI.0000000000000956