Pope Kosalaraksa1, David C Boettiger2, Torsak Bunupuradah3, Rawiwan Hansudewechakul4, Sarun Saramony5, Viet C Do6, Tavitiya Sudjaritruk7, Nik K N Yusoff8, Kamarul A M Razali9, Lam V Nguyen10, Revathy Nallusamy11, Siew M Fong12, Nia Kurniati13, Khanh H Truong14, Annette H Sohn15, Kulkanya Chokephaibulkit16. 1. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand. 2. The Kirby Institute, University of New South Wales Australia, Sydney. 3. HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, and. 4. Chiangrai Prachanukroh Hospital, Thailand. 5. University of Health Sciences, Phnom Penh, Cambodia. 6. Children's Hospital 2, Ho Chi Minh City, Vietnam. 7. Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Thailand. 8. Hospital Raja Perempuan Zainab II, Kelantan, and. 9. Pediatric Institute, Hospital Kuala Lumpur, Malaysia. 10. National Hospital of Pediatrics, Hanoi, Vietnam. 11. Penang Hospital, and. 12. Hospital Likas, Kota Kinabalu, Malaysia. 13. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. 14. Children's Hospital 1, Ho Chi Minh City, Vietnam. 15. TREAT Asia/amfAR, The Foundation for AIDS Research, and. 16. Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract
BACKGROUND.: Regular CD4 count testing is often used to monitor antiretroviral therapy efficacy. However, this practice may be redundant in children with a suppressed human immunodeficiency virus (HIV) viral load. METHODS: Study end points were as follows: (1) a CD4 count <200 cells/mm3 followed by a CD4 count ≥200 cells/mm3 (transient CD4 <200); (2) CD4 count <200 cells/mm3 confirmed within 6 months (confirmed CD4 <200); and (3) a new or recurrent World Health Organization (WHO) stage 3 or 4 illness (clinical failure). Kaplan-Meier curves and Cox regression were used to evaluate rates and predictors of transient CD4 <200, confirmed CD4 <200, and clinical failure among virally suppressed children aged 5-15 years who were enrolled in the TREAT Asia Pediatric HIV Observational Database. RESULTS: Data from 967 children were included in the analysis. At the time of confirmed viral suppression, median age was 10.2 years, 50.4% of children were female, and 95.4% were perinatally infected with HIV. Median CD4 cell count was 837 cells/mm3, and 54.8% of children were classified as having WHO stage 3 or 4 disease. In total, 18 transient CD4 <200 events, 2 confirmed CD4 <200 events, and10 clinical failures occurred at rates of 0.73 (95% confidence interval [95% CI], 0.46-1.16), 0.08 (95% CI, 0.02-0.32), and 0.40 (95% CI, 0.22-0.75) events per 100 patient-years, respectively. CD4 <500 cells/mm3 at the time of viral suppression confirmation was associated with higher rates of both CD4 outcomes. CONCLUSIONS: Regular CD4 testing may be unnecessary for virally suppressed children aged 5-15 years with CD4 ≥500 cells/mm3.
BACKGROUND.: Regular CD4 count testing is often used to monitor antiretroviral therapy efficacy. However, this practice may be redundant in children with a suppressed human immunodeficiency virus (HIV) viral load. METHODS: Study end points were as follows: (1) a CD4 count <200 cells/mm3 followed by a CD4 count ≥200 cells/mm3 (transient CD4 <200); (2) CD4 count <200 cells/mm3 confirmed within 6 months (confirmed CD4 <200); and (3) a new or recurrent World Health Organization (WHO) stage 3 or 4 illness (clinical failure). Kaplan-Meier curves and Cox regression were used to evaluate rates and predictors of transient CD4 <200, confirmed CD4 <200, and clinical failure among virally suppressed children aged 5-15 years who were enrolled in the TREAT Asia Pediatric HIV Observational Database. RESULTS: Data from 967 children were included in the analysis. At the time of confirmed viral suppression, median age was 10.2 years, 50.4% of children were female, and 95.4% were perinatally infected with HIV. Median CD4 cell count was 837 cells/mm3, and 54.8% of children were classified as having WHO stage 3 or 4 disease. In total, 18 transient CD4 <200 events, 2 confirmed CD4 <200 events, and10 clinical failures occurred at rates of 0.73 (95% confidence interval [95% CI], 0.46-1.16), 0.08 (95% CI, 0.02-0.32), and 0.40 (95% CI, 0.22-0.75) events per 100 patient-years, respectively. CD4 <500 cells/mm3 at the time of viral suppression confirmation was associated with higher rates of both CD4 outcomes. CONCLUSIONS: Regular CD4 testing may be unnecessary for virally suppressed children aged 5-15 years with CD4 ≥500 cells/mm3.
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