Is it still worthwhile to perform quarterly cd4+ t lymphocyte cell counts on hiv-1 infected stable patients?

BMC Infectious Diseases

Research Article

Marta Ameri¹  Enrico Di Bella¹  Marcello Montefiori¹  Barbara Giannini²  Mauro Giacomini²  Antonio Di Biagio³  Davide Sirello³  Lucia Taramasso³  Claudio Viscoli³  Giovanni Cenderello⁴  Giovanni Cassola⁴ 

[1] Department of Economics, University of Genoa, Via Vivaldi 5, 16126, Genoa, Italy;Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy;Infectious Disease Clinic, IRCCS San Martino – IST Hospital, Genoa, Italy;Infectious Diseases Unit, EO Galliera, Genoa, Italy;

关键词: Lymphocyte T CD4+;    Cost;    HIV;    Monitoring;   

DOI  :  10.1186/s12879-017-2199-x

 received in 2016-07-14, accepted in 2017-01-10,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn the last 20 years routine T CD4+ lymphocyte (CD4+) cell count has proved to be a key factor to determine the stage of HIV infection and start or discontinue of prophylaxis for opportunistic infections. However, several studies recently showed that in stable patients on cART a quarterly CD4+ cell count monitoring results in limited (or null) clinical relevance. The research is intended to investigate whether performing quarterly CD4+ cell counts in stable HIV-1 patients is still recommendable and to provide a forecast of the cost saving that could be achieved by reducing CD4+ monitoring in such a category of patients.MethodsThe study is based on data referring to all HIV-infected patients > 18 years of age being treated at two large infectious diseases units located in the metropolitan area of Genoa, Italy. The probability of CD4+ cell counts dropping below a threshold value set at 350 cells/mm3 is assessed using confidence intervals and Kaplan-Meier survival estimates, whereas multivariate Cox analysis and logistic regression are implemented in order to identify factors associated with CD4+ cell count falls below 350 cells/mm3.ResultsStatistical analysis reveals that among stable patients the probability of maintaining CD4+ >350 cell/mm3 is more than 98%. Econometric models indicate that HCV co-infection and HIV-RNA values >50 copies/mL in previous examinations are associated with CD4+ falls below 350 cells/mm3. Moreover, results suggest that the cost saving that could be obtained by reducing CD4+ examinations ranges from 33 to 67%.ConclusionsEmpirical findings shows that patients defined as stable at enrollment are highly unlikely to experience a CD4+ value <350 cell/mm3 in the space/arc of a year. The research supports a recommendation for annual CD4+ monitoring in stable HIV-1 patients.

【 授权许可】

CC BY   
© The Author(s). 2017