How often should CD4 cells be monitored in virologically suppressed patients?


Data from several major prospective studies was used to compare dynamic monitoring strategies for CD4 counts. 47,635 patients were included in the study from year 2000 until 2015. Three different CD4 thresholds of 200, 350 and 500 cells/mL were used. For each threshold frequency of measurement (every 3-6 months or every 9-12 months) of CD4 and viral load was compared above and below the threshold and correlated to hazard ratios of death, AIDS-defining illness or death, risk ratios of virological failure and mean differences in CD4 cell count. The authors conclude that in virologically suppressed patients with a CD4 count above 200 cells/μL, annual monitoring does not worsen short term outcome compared to patients with a CD4 count above 500.

Caniglia et al. Lancet HIV 2017;published online

Comment: This large and statistically complicated study provides evidence for once yearly monitoring of CD4 count in virologically suppressed patients with more than 200 CD4 cells/μL. One could even argue that CD4 counts in stable patients may be of limited or even no clinical value. Perhaps it would be as effective to measure viral load only. For the time being it seems like a pragmatic approach to measure CD4 once a year.