CD4 Cell Percentage Predicts Disease Progression in HIV Patients Initiating HAART with CD4 Counts >350 cells/mm3

The percentage of CD4 cells predicts HIV disease progression among those HIV patients who start therapy with >350 CD4 cells/mm³, and this information helps to identify those who will gain the greatest benefits from starting HAART. Researchers came to these conclusions based on the findings of a study published in the September 15, 2005 issue of The Journal of Infectious Diseases.

The optimal timing for initiating HAART in HIV-infected patients with >/= 200 absolute CD4 lymphocytes/mm3 is unknown. The purpose of the current study was to determine whether the CD4 lymphocyte percentage could add prognostic information.

Included in this study were persons who initiated HAART between 1 January 1998 and 1 January 2003, received >/= 30 days of therapy, and had baseline CD4 lymphocyte data available.

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 <17% was the strongest predictor of disease progression among subjects in this latter group (P = .045).

Discussion

There may be persons with absolute CD4 lymphocyte counts >/=200 lymphocytes/mm³ who could derive greater benefit from earlier initiation of HAART, compared with others. According to the researchers, identifying such persons would be extremely important and would help to clarify the optimal timing of initiation of HAART. CD4 lymphocyte percentage could potentially assist in the identification of these persons and, therefore, in treatment decisions.

The most notable finding of the present study was that CD4 lymphocyte percentage <17% was associated with an increased risk of clinical disease progression among subjects with baseline absolute CD4 lymphocyte counts >350 lymphocytes/mm³ [emphasis added-Ed]

Low CD4 lymphocyte percentage was of borderline statistical significance for patients with absolute CD4 lymphocyte counts >/=200 lymphocytes/mm³, but it was statistically significant for those with absolute CD4 lymphocyte counts >350 lymphocytes/mm³.

For this subject group CD4 lymphocyte percentage <17% was the strongest predictor of disease progression. The authors note that although additional studies with larger populations are needed to confirm these findings, they are consistent with those from studies from the pre-HAART era, which found CD4 lymphocyte percentage to be a better predictor of disease progression than absolute CD4 lymphocyte count.

Summary

In closing the authors write, “The following conclusions can be drawn from the present study: CD4 lymphocyte percentage <17% before initiation of the first HAART regimen predicted subsequent clinical disease progression in persons with baseline absolute CD4 lymphocyte counts >350 lymphocytes/mm³. Although validation in additional cohorts is needed, these findings suggest that CD4 lymphocyte percentage may assist in identifying persons with higher absolute CD4 lymphocyte counts who would benefit most from early initiation of HAART.”

Department of Medicine, Division of Infectious Diseases, and Center for Health Services Research, Vanderbilt University School of Medicine, and Comprehensive Care Center, Nashville, Tennessee.

08/26/05

Reference
T Hulgan and others. CD4 Lymphocyte Percentage Predicts Disease Progression in HIV-Infected Patients Initiating Highly Active Antiretroviral Therapy with CD4 Lymphocyte Counts >350 Lymphocytes/mm³. The Journal of Infectious Diseases 192(6): 945-947. September 15, 2005.

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