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Low CD4-Cell Counts — Not Just About OI Risk

In a cohort of patients receiving ART, lower CD4-cell counts increased the risk not only for AIDS-defining conditions but also for non–AIDS-defining disease.

Lower CD4-cell counts among HIV-infected people are associated with increased risk for AIDS-defining opportunistic diseases. The widespread use of combination antiretroviral therapy (ART) has decreased the frequency of these illnesses, resulting in longer survival and a relative increase in the rate of non–AIDS-defining conditions (ACC Oct 2 2006). To evaluate the link between low CD4-cell counts and non-AIDS diseases, investigators reviewed data from 1397 patients who initiated ART as part of the FIRST trial (median follow-up, 5 years).

As shown in Table 1, higher latest CD4-cell count was associated with a lower rate of both AIDS and non-AIDS diagnoses. After adjusting for age, sex, race, current viral load, previous AIDS events, and hepatitis coinfection, researchers found that the risk for AIDS was lowered by 44% — and the risk for non-AIDS disease by 14% — with each 100-cell/mm³ increase in latest CD4 count.

Comment: Consistent with other studies, this analysis indicates that maintaining high CD4-cell counts reduces the risk not only for AIDS-defining conditions but also for non–AIDS-defining disease. Overall, the collective evidence suggests that it is time to revisit the recommendations for when to initiate ART.

— Charles B. Hicks, MD

Published in AIDS Clinical Care May 12, 2008

Citation(s):

Baker JV et al. CD4+ count and risk of non-AIDS diseases following initial treatment for HIV infection. AIDS 2008 Apr 23; 22:841.

• Medline abstract (Free)