CD4 Lymphocyte Percentage Predicts Disease Progression in HIV-Infected Patients Initiating Highly Active Antiretroviral Therapy with CD4 Lymphocyte Counts >350 Lymphocytes/mm3

Hulqan, Todd; Raffanti, Stephen; Kheshti, Asqhar; Blackwell, Robert B.; Rebeiro, Peter F.; Barkanic, Gema; Ritz, Brandon; Sterling, Timothy R.
September 2005
Journal of Infectious Diseases;9/15/2005, Vol. 192 Issue 6, p950
Academic Journal
Background. The optimal timing of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected patients with ⩾200 absolute CD4 lymphocytes/mm³ is unknown. CD4 lymphocyte percentage could add prognostic information. Methods. Persons who initiated HAART between 1 January 1998 and 1 January 2003, received ⩾30 days of therapy, and had baseline CD4 lymphocyte data available were included in the study. The log-rank test for time to event and Cox proportional hazards models were used to determine predictors of a new acquired immunodeficiency syndrome–defining illness or death. Results. A total of 788 patients met the inclusion criteria. At baseline, subjects had a median of 225 CD4 lymphocytes/mm³ and 17% CD4 lymphocytes. Subjects with <17% CD4 lymphocytes had earlier disease progression, compared with subjects with ⩾17%, both in the entire cohort (P < .0001) and of those subjects with >350 absolute CD4 lymphocytes/mm³ at baseline (P = .03). CD4 lymphocyte percentage <% was the strongest predictor of disease progression among subjects in this latter group (hazard ratio, 3.57; P = .045). Conclusions. In this cohort, CD4 lymphocyte percentage predicted disease progression in HIV-infected subjects who initiated therapy with >350 CD4 lymphocytes/mm³. This information may help identify persons who will derive the greatest benefit from initiation of HAART.


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