CD4-Cell Nadir Before ART and Serious Non-AIDS Events

Keith Henry, MD

In HIV-infected patients with baseline CD4 counts >500 cells/mm3, a CD4 nadir <350 cells/mm3 before ART initiation was associated with a higher rate of serious non-AIDS events.

Despite emerging expert opinion recommending antiretroviral therapy (ART) initiation at high CD4 counts (i.e., >500 cells/mm3), data documenting the clinical benefit remain limited. Now, researchers in Spain summarize their experience with HIV-infected patients who had CD4 counts >500 cells/mm3 at baseline and for at least 1 year of follow-up.

Of the 574 patients (median age, 43; median baseline CD4 count, 630 cells/mm3; median baseline viral load, 4 log copies/mL), 80% were men, 57% were men who have sex with men, and 28% had hepatitis C virus coinfection. During a median follow-up of 10 years, 78% initiated ART. Severe non-AIDS clinical events were defined as first hospital admissions for non–AIDS-defining cancers or cardiovascular, neuropsychiatric, liver-related, or end-stage renal disease events.

Eighty-five severe non-AIDS events (39% non-AIDS cancers, 23% cardiovascular events), 48 AIDS events (32% tuberculosis, 13% Kaposi sarcoma), and 8 deaths (6 from non-AIDS causes) occurred during follow-up. The crude incidence rate for non-AIDS/death events was 1.4 per 100 patient-years of follow-up. A reduction of the crude incidence rate for non-AIDS events after ART initiation was noted only in patients with a CD4 nadir >350 cells/mm3 (0.6 vs. 2.5 per 100 patient-years of follow-up; P<0.0001).

Citation(s):

Lucero C et al. Rate and predictors of non-AIDS events in a cohort of HIV-infected patients with a CD4 T cell count above 500 cells/mm3. AIDS Res Hum Retroviruses 2013 Aug; 29:1161.