When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study

Ellen C Caniglia; Caroline Sabin; James M Robins; Roger Logan; Lauren E Cain; Sophie Abgrall; Michael J Mugavero; Sonia Hernandez-Diaz; Laurence Meyer; Remonie Seng; Daniel R Drozd; George R Seage; Fabrice Bonnet; Francois Dabis; Richard R Moore; Peter Reiss; Ard van Sighem; William C Mathews; Julia Del Amo; Santiago Moreno; Steven G Deeks; Roberto Muga; Stephen L Boswell; Elena Ferrer; Joseph J Eron; Sonia Napravnik; Sophie Jose; Andrew Phillips; Ashley Olson; Amy C Justice; Janet P Tate; Heiner C Bucher; Matthias Egger; Giota Touloumi; Jonathan A Sterne; Dominique Costagliola; Michael Saag; Miguel A Hernán; Center for AIDS Research Network of Integrated Clinical Systems and the HIV-CAUSAL Collaboration

doi:10.1097/QAI.0000000000000956

When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study

Ellen C Caniglia, Caroline Sabin, James M Robins, Roger Logan, Lauren E Cain, Sophie Abgrall, Michael J Mugavero, Sonia Hernandez-Diaz, Laurence Meyer, Remonie Seng, Daniel R Drozd, George R Seage, Fabrice Bonnet, Francois Dabis, Richard R Moore, Peter Reiss, Ard van Sighem, William C Mathews, Julia Del Amo, Santiago MorenoSteven G Deeks, Roberto Muga, Stephen L Boswell, Elena Ferrer, Joseph J Eron, Sonia Napravnik, Sophie Jose, Andrew Phillips, Ashley Olson, Amy C Justice, Janet P Tate, Heiner C Bucher, Matthias Egger, Giota Touloumi, Jonathan A Sterne, Dominique Costagliola, Michael Saag, Miguel A Hernán, Center for AIDS Research Network of Integrated Clinical Systems and the HIV-CAUSAL Collaboration

Research output: Contribution to journal › Article (Academic Journal) › peer-review

15 Citations (Scopus)

206 Downloads (Pure)

Abstract

OBJECTIVE: To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART).

DESIGN: Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems.

METHODS: Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes.

RESULTS: In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies.

CONCLUSIONS: Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.

Original language	English
Pages (from-to)	214-221
Number of pages	8
Journal	Journal of Acquired Immune Deficiency Syndromes
Volume	72
Issue number	2
Early online date	1 Jun 2016
DOIs	https://doi.org/10.1097/QAI.0000000000000956
Publication status	Published - 1 Jun 2016

Keywords

HIV
CD4 cell count
HIV RNA
monitoring
observational studies
mortality

Access to Document

10.1097/QAI.0000000000000956

Full-text PDF (accepted author manuscript)
This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Wolters Kluwer at https://journals.lww.com/jaids/fulltext/2016/06010/When_to_Monitor_CD4_Cell_Count_and_HIV_RNA_to.15.aspx . Please refer to any applicable terms of use of the publisher.
Accepted author manuscript, 769 KB

Handle.net

Persistent link

Fingerprint

Dive into the research topics of 'When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study'. Together they form a unique fingerprint.

ART-CC: Prognosis of HIV-infected patients treated with ART
Sterne, J. A. C., Ingle, S. M. & May, M. T.
1/02/12 → 1/02/15
Project: Research

Cite this

Caniglia, E. C., Sabin, C., Robins, J. M., Logan, R., Cain, L. E., Abgrall, S., Mugavero, M. J., Hernandez-Diaz, S., Meyer, L., Seng, R., Drozd, D. R., Seage, G. R., Bonnet, F., Dabis, F., Moore, R. R., Reiss, P., van Sighem, A., Mathews, W. C., Del Amo, J., ... Center for AIDS Research Network of Integrated Clinical Systems and the HIV-CAUSAL Collaboration (2016). When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study. Journal of Acquired Immune Deficiency Syndromes, 72(2), 214-221. https://doi.org/10.1097/QAI.0000000000000956

Caniglia, Ellen C ; Sabin, Caroline ; Robins, James M et al. / When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries : A Prospective Observational Study. In: Journal of Acquired Immune Deficiency Syndromes. 2016 ; Vol. 72, No. 2. pp. 214-221.

@article{815baa48382c4ba7b35b2d7d47f78938,

title = "When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study",

abstract = "OBJECTIVE: To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART).DESIGN: Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems.METHODS: Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes.RESULTS: In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies.CONCLUSIONS: Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.",

keywords = "HIV, CD4 cell count, HIV RNA, monitoring, observational studies, mortality",

author = "Caniglia, {Ellen C} and Caroline Sabin and Robins, {James M} and Roger Logan and Cain, {Lauren E} and Sophie Abgrall and Mugavero, {Michael J} and Sonia Hernandez-Diaz and Laurence Meyer and Remonie Seng and Drozd, {Daniel R} and Seage, {George R} and Fabrice Bonnet and Francois Dabis and Moore, {Richard R} and Peter Reiss and {van Sighem}, Ard and Mathews, {William C} and {Del Amo}, Julia and Santiago Moreno and Deeks, {Steven G} and Roberto Muga and Boswell, {Stephen L} and Elena Ferrer and Eron, {Joseph J} and Sonia Napravnik and Sophie Jose and Andrew Phillips and Ashley Olson and Justice, {Amy C} and Tate, {Janet P} and Bucher, {Heiner C} and Matthias Egger and Giota Touloumi and Sterne, {Jonathan A} and Dominique Costagliola and Michael Saag and Hern{\'a}n, {Miguel A} and {Center for AIDS Research Network of Integrated Clinical Systems and the HIV-CAUSAL Collaboration}",

year = "2016",

month = jun,

day = "1",

doi = "10.1097/QAI.0000000000000956",

language = "English",

volume = "72",

pages = "214--221",

journal = "Journal of Acquired Immune Deficiency Syndromes",

issn = "1525-4135",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

Caniglia, EC, Sabin, C, Robins, JM, Logan, R, Cain, LE, Abgrall, S, Mugavero, MJ, Hernandez-Diaz, S, Meyer, L, Seng, R, Drozd, DR, Seage, GR, Bonnet, F, Dabis, F, Moore, RR, Reiss, P, van Sighem, A, Mathews, WC, Del Amo, J, Moreno, S, Deeks, SG, Muga, R, Boswell, SL, Ferrer, E, Eron, JJ, Napravnik, S, Jose, S, Phillips, A, Olson, A, Justice, AC, Tate, JP, Bucher, HC, Egger, M, Touloumi, G, Sterne, JA, Costagliola, D, Saag, M, Hernán, MA & Center for AIDS Research Network of Integrated Clinical Systems and the HIV-CAUSAL Collaboration 2016, 'When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study', Journal of Acquired Immune Deficiency Syndromes, vol. 72, no. 2, pp. 214-221. https://doi.org/10.1097/QAI.0000000000000956

When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries : A Prospective Observational Study. / Caniglia, Ellen C; Sabin, Caroline; Robins, James M et al.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 72, No. 2, 01.06.2016, p. 214-221.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries

T2 - A Prospective Observational Study

AU - Caniglia, Ellen C

AU - Sabin, Caroline

AU - Robins, James M

AU - Logan, Roger

AU - Cain, Lauren E

AU - Abgrall, Sophie

AU - Mugavero, Michael J

AU - Hernandez-Diaz, Sonia

AU - Meyer, Laurence

AU - Seng, Remonie

AU - Drozd, Daniel R

AU - Seage, George R

AU - Bonnet, Fabrice

AU - Dabis, Francois

AU - Moore, Richard R

AU - Reiss, Peter

AU - van Sighem, Ard

AU - Mathews, William C

AU - Del Amo, Julia

AU - Moreno, Santiago

AU - Deeks, Steven G

AU - Muga, Roberto

AU - Boswell, Stephen L

AU - Ferrer, Elena

AU - Eron, Joseph J

AU - Napravnik, Sonia

AU - Jose, Sophie

AU - Phillips, Andrew

AU - Olson, Ashley

AU - Justice, Amy C

AU - Tate, Janet P

AU - Bucher, Heiner C

AU - Egger, Matthias

AU - Touloumi, Giota

AU - Sterne, Jonathan A

AU - Costagliola, Dominique

AU - Saag, Michael

AU - Hernán, Miguel A

AU - Center for AIDS Research Network of Integrated Clinical Systems and the HIV-CAUSAL Collaboration

PY - 2016/6/1

Y1 - 2016/6/1

N2 - OBJECTIVE: To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART).DESIGN: Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems.METHODS: Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes.RESULTS: In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies.CONCLUSIONS: Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.

AB - OBJECTIVE: To illustrate an approach to compare CD4 cell count and HIV-RNA monitoring strategies in HIV-positive individuals on antiretroviral therapy (ART).DESIGN: Prospective studies of HIV-positive individuals in Europe and the USA in the HIV-CAUSAL Collaboration and The Center for AIDS Research Network of Integrated Clinical Systems.METHODS: Antiretroviral-naive individuals who initiated ART and became virologically suppressed within 12 months were followed from the date of suppression. We compared 3 CD4 cell count and HIV-RNA monitoring strategies: once every (1) 3 ± 1 months, (2) 6 ± 1 months, and (3) 9-12 ± 1 months. We used inverse-probability weighted models to compare these strategies with respect to clinical, immunologic, and virologic outcomes.RESULTS: In 39,029 eligible individuals, there were 265 deaths and 690 AIDS-defining illnesses or deaths. Compared with the 3-month strategy, the mortality hazard ratios (95% CIs) were 0.86 (0.42 to 1.78) for the 6 months and 0.82 (0.46 to 1.47) for the 9-12 month strategy. The respective 18-month risk ratios (95% CIs) of virologic failure (RNA >200) were 0.74 (0.46 to 1.19) and 2.35 (1.56 to 3.54) and 18-month mean CD4 differences (95% CIs) were -5.3 (-18.6 to 7.9) and -31.7 (-52.0 to -11.3). The estimates for the 2-year risk of AIDS-defining illness or death were similar across strategies.CONCLUSIONS: Our findings suggest that monitoring frequency of virologically suppressed individuals can be decreased from every 3 months to every 6, 9, or 12 months with respect to clinical outcomes. Because effects of different monitoring strategies could take years to materialize, longer follow-up is needed to fully evaluate this question.

KW - HIV

KW - CD4 cell count

KW - HIV RNA

KW - monitoring

KW - observational studies

KW - mortality

U2 - 10.1097/QAI.0000000000000956

DO - 10.1097/QAI.0000000000000956

M3 - Article (Academic Journal)

C2 - 26895294

VL - 72

SP - 214

EP - 221

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 2

ER -

Caniglia EC, Sabin C, Robins JM, Logan R, Cain LE, Abgrall S et al. When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study. Journal of Acquired Immune Deficiency Syndromes. 2016 Jun 1;72(2):214-221. Epub 2016 Jun 1. doi: 10.1097/QAI.0000000000000956

When to Monitor CD4 Cell Count and HIV RNA to Reduce Mortality and AIDS-Defining Illness in Virologically Suppressed HIV-Positive Persons on Antiretroviral Therapy in High-Income Countries: A Prospective Observational Study

Abstract

Keywords

Access to Document

Handle.net

Fingerprint

Projects

ART-CC: Prognosis of HIV-infected patients treated with ART

Cite this