CD4 Decline Is Associated With Increased Risk of Cardiovascular Disease, Cancer, and Death in Virally Suppressed Patients With HIV

February 20, 2017 at 3:23 pm

Clinical Infectious Diseases July 15, 2013 V.57 N.2 P.314-321

Marie Helleberg, Gitte Kronborg, Carsten S. Larsen, Gitte Pedersen, Court Pedersen, Niels Obel, and Jan Gerstoft

1Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet

2Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre

3Department. of Infectious Diseases, Aarhus University Hospital, Skejby

4Department of Infectious Diseases, Aalborg University Hospital

5Deptartment of Infectious Diseases, Odense University Hospital, Denmark

Background

The clinical implications of a considerable CD4 decline despite antiretroviral treatment and viral suppression are unknown. We aimed to test the hypothesis that a major CD4 decline could be a marker of cardiovascular disease or undiagnosed cancer.

Methods

Patients with human immunodeficiency virus (HIV) were followed in the Danish nationwide, population-based cohort study in the period 1995–2010 with quarterly CD4 measurements. Associations between a CD4 decline of ≥30% and cardiovascular disease, cancer, and death were analyzed using Poisson regression with date of CD4 decline as a time-updated variable.

Results

We followed 2584 virally suppressed HIV patients for 13 369 person-years (PY; median observation time, 4.7 years). Fifty-six patients developed CD4 decline (incidence rate, 4.2/1000 PY [95% confidence interval {CI}, 3.2–5.4]). CD4 counts dropped from a median of 492 cells/µL to 240 cells/µL. CD8, CD3, and total lymphocyte counts dropped concomitantly. No HIV-related factors, apart from treatment with didanosine, were associated with CD4 decline. The risk of cardiovascular disease, cancer, and death increased markedly ≤6 months after CD4 decline (incidence rate ratio, 11.7 [95% CI, 3.6–37.4] and 13.7 [95% CI, 4.3–43.6], respectively, and mortality rate ratio 4.3 [95% CI, 1.1–17.6]).

Conclusion

A major decline in CD4 count is associated with a marked increased risk of cardiovascular disease, cancer, and death among virally suppressed HIV patients. We studied the clinical implications of CD4 decline among virally suppressed human immunodeficiency virus patients and found that the risk of cardiovascular disease, cancer, and death was substantially increased within 6 months after a major CD4 decline and moderately increased thereafter.

PDF

http://cid.oxfordjournals.org/content/57/2/314.full.pdf

Advertisements

Entry filed under: Antirretrovirales, Epidemiología, HIV/SIDA, HIV/SIDA Laboratorio, Metodos diagnosticos, Update.

Infectious Complications Following Transrectal Ultrasound–Guided Prostate Biopsy: New Challenges in the Era of Multidrug-Resistant Escherichia coli Revisiones – Diagnóstico microbiológico de las hepatitis virales


Calendar

February 2017
M T W T F S S
« Jan   Mar »
 12345
6789101112
13141516171819
20212223242526
2728  

Most Recent Posts


%d bloggers like this: