HIV diagnosis at CD4 count above 500 cells/mm3 and progression to below 350 cells/mm3 without antiretroviral therapy

Andrew N. Phillips*, Richard Gilson, Philippa Easterbrook, Martin Fisher, Brian Gazzard, Margaret Johnson, John Walsh, Clifford Leen, Chloe Orkin, Jane Anderson, Deenan Pillay, Valerie Delpech, Achim Schwenk, David Dunn, Mark Gompels, Teresa Hill, Kholoud Porter, Abdel Babiker, Caroline Sabin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

A trial to evaluate the risks and benefits of initiation of antiretroviral therapy (ART) in patients with high CD4 count (eg, ≥500 cells/mm), in comparison with deferral (eg, to <350 cells/mm), merits consideration. Two issues for consideration in designing such a trial are the proportion of patients seen in clinics who present with high CD4 count and the time it will take for those randomized to deferring ART to reach a level where ART must be initiated. Among 13,572 patients in the UK CHIC Study presenting since 1996, 3631 (27%) had a count ≥500 cells/mm. Among 4268 ART-naive patients with at least one CD4 count in the 500 to 650 cells/mm range, the median time to <350 cells/mm (or start of ART) was 2.5 years, with a range of 2.1 to 3.1 years depending on the analysis approach. Viral load at baseline was a strong predictor of the time taken for the CD4 count to reach <350 cells/mm, with the median ranging from 0.7 years in those with viral load ≥500,000 copies/mL to 4.7 years in those with <1000 copies/mL. This provides timely background data on ART-naive patients seen in clinical practice to support design of a trial to compare immediate with deferred ART in people with high CD4 count.

Original languageEnglish
Pages (from-to)275-278
Number of pages4
JournalJournal of Acquired Immune Deficiency Syndromes
Volume46
Issue number3
DOIs
Publication statusPublished - 1 Nov 2007

Keywords

  • Antiretroviral therapy
  • CD4 count decline
  • Presentation
  • When to start

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