Does Discordancy Between the CD4 Count and CD4 Percentage in HIV-Positive Individuals Influence Outcomes on Highly Active Antiretroviral Therapy?

Mark Gompels, David T. Dunn, Andrew Phillips, Debbie Dooley, Andrew De Burgh Thomas, Jane Anderson, Frank Post, Deenan Pillay, Brian Gazzard, Teresa Hill, Margaret Johnson, Richard Gilson, Loveleen Bansi, Philippa Easterbrook, Martin Fisher, John Walsh, Chloe Orkin, Jonathan Ainsworth, Clifford Leen, Caroline SabinUK Collaborative HIV Cohort UK CHI

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)540-547
Number of pages8
JournalThe Journal of Infectious Diseases
Volume205
Issue number4
DOIs
Publication statusPublished - 15 Feb 2012

Keywords

  • Adult
  • Anti-HIV Agents
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Drug Monitoring
  • Female
  • HIV Infections
  • Humans
  • Male
  • Middle Aged
  • Treatment Outcome

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