Can we stop CD4 super(+) testing in patients with HIV-1 RNA suppression on antiretroviral treatment?

• Published in: AIDS (London) Vol. 27; no. 17; pp. 2759 - 2763
• Main Authors: Girard, Pierre-Marie, Nelson, Mark, Mohammed, Perry, Hill, Andrew, van Delft, Yvon, Moecklinghoff, Christiane
• Format: Journal Article
• Language: English
• Published: 13.11.2013
• Subjects: Human immunodeficiency virus 1; Lentivirus
• ISSN: 0269-9370
• DOI: 10.1097/01.aids.0000432458.98851.c1

Background: It is unclear whether regular CD4 super(+) testing is necessary for all patients during long-term antiretroviral treatment, after patients achieve full HIV-1 RNA suppression. Methods: In the AntiRetroviral Therapy with TMC114 Examined in Naive Subjects (ARTEMIS) trial, 689 treatment-naive patients were randomized to tenofovir/emtricitabine and either darunavir/ritonavir or lopinavir/ritonavir. The number of patients with CD4 super(+) cell counts equal or above 200 copies/ml and HIV-1 RNA below 50 copies/ml at week 48 was assessed. For these patients, we assessed whether CD4 super(+) cell counts fell below 200 cells/ mu l from week 49 to week 192, while HIV-1 RNA suppression was maintained. Results: Of the 520 responders, five (1.0%) progressed to an AIDS-defining event during the first 48 weeks of the trial, whereas 19 of the 169 non-responders (11.2%) developed AIDS-defining events during this time (P = 0.001, Fisher's Exact test). Of the 449 patients with sustained HIV-1 RNA suppression below 400 copies/ml from week 49 to week 192, five patients (1.1%) had reductions in CD4 super(+) cell count below 200 cells/ mu l on two consecutive visits. These were all short-term reductions, with follow-up results equal or above 200 cells/ mu l. Conclusions: There was a benefit to testing for CD4 super(+) cell count in the first 48 weeks of treatment, to identify patients who have immuno-virological discordance and therefore a higher risk of progression to AIDS. However, after 48 weeks of antiretroviral treatment, for the 'responder' patients in the ARTEMIS trial who had both HIV-1 RNA below 50 copies/ml and rises in CD4 super(+) cell count equal or above 200 cells/ mu l, there appears to be little clinical benefit from continued testing for CD4 super(+) cell count.