Setting a minimum threshold CD4 count for initiation of highly active antiretroviral therapy in HIV-infected patients
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AbstractThe aim of our study was to determine a minimum threshold CD4 count for highly active antiretroviral therapy (HAART) initiation in HIV-infected patients. A schema using longitudinal data from a clinical cohort was designed. The presenting CD4 counts of asymptomatic HIV-infected patients in Hong Kong were evaluated in relation to their progression to AIDS within 1 year of diagnosis of HIV infection. A graph was generated to depict the changes in the percentage of cumulative AIDS diagnoses for every 10 cell/mu L increase in presenting CD4 count. Of 181 patients, 24 had developed AIDS within 1 year of diagnosis of HIV infection. Setting the CD4 count threshold at 150 cells/mu L gave a good balance between the number of preventable AIDS-defining events and the number of non-AIDS patients initiating HAART. No extra AIDS-defining events occurred when the CD4 count threshold was reduced from 200 to 150 cells/mu L, despite the addition of 13 more patients. In multivariate Cox regression analysis, presenting CD4 count was a significant predictor for AIDS occurrence. The relative hazard for AIDS occurrence of patients with presenting CD4 counts <= 150 cells/mu L was 27-fold greater. We suggest a CD4 count of 150 cells/mu L as the minimum threshold for HAART initiation in a cohort of Chinese HIV-infected patients. At this level, 20.8% of the AIDS-defining events could be prevented. While a cut-off of 200 cells/mu L remains a standard for considering HAART initiation, the minimum threshold signifies a critical moment for timely intervention to be introduced.
All Author(s) ListHo CF, Lee SS, Wong KH, Cheng LS, Lam MY
Journal nameHIV Medicine
Year2007
Month4
Day1
Volume Number8
Issue Number3
PublisherBLACKWELL PUBLISHING
Pages181 - 185
ISSN1464-2662
eISSN1468-1293
LanguagesEnglish-United Kingdom
KeywordsCD4 threshold; Chinese HIV-infected patients; HAART
Web of Science Subject CategoriesInfectious Diseases; INFECTIOUS DISEASES

Last updated on 2020-30-10 at 00:56