[O21] Utility of CD4 count monitoring in patients on HAART who maintain viral load (VL) suppression – experience from the VS arm (continuous ART) of the SMART study (Strategies for Management of Antiretroviral Therapy study)

14th Annual Conference of the British HIV Association

23–25 April 2008, Belfast

UTILITY OF CD4 COUNT MONITORING IN PATIENTS ON HAART WHO MAINTAIN VIRAL LOAD (VL) SUPPRESSION – EXPERIENCE FROM THE VS ARM (CONTINUOUS ART) OF THE SMART STUDY (STRATEGIES FOR MANAGEMENT OF ANTIRETROVIRAL THERAPY STUDY)

HIV Med 2008; 9(Suppl. 1):6 (abstract no. O21)

DN Chilton¹, J Neuhaus², A Palfreeman³, SG Edwards¹ and IG Williams⁴
¹Mortimer Market Centre, London, UK, ²University of Minnesota, Minnesota, USA, ³Medical Research Council, London, UK, ⁴Centre for Sexual Health and HIV Research, UCL, London, UK

BACKGROUND: In the VS arm of the SMART study, higher proximal VL and older age were predictive of HIV disease progression. CD4 monitoring in patients on HAART with a VL <50 and good CD4 recovery may thus be of limited clinical utility. To help guide clinical practice, we provide data on the absolute risks of disease progression in the SMART study.

METHODS: We investigated outcomes in patients randomized to the viral suppression (VS) arm of the SMART study. All patients received continuous HAART and had a baseline CD4 >350 × 10⁶. Analysis was restricted to the first 12 months of follow up (FU) in patients who had completed 12 months.

RESULTS: Two thousand seven hundred and fifty two patients were randomized to the VS arm; 45 died or were lost to FU within 1 year, and were excluded.


	VL<50 n:691	VL<400 n:1476	VL>400 n:1231

Opportunistic disease (OD) (n)	4	6	11
Rate OD (/100py)	0.6	0.4	0.9
Non OD events (n)	5	9	7
Non OD event rate (/100py)	0.7	0.6	0.6
Rate CD4 decline <350 (/100py)	12.7	13.4	30.8
Follow up time with CD4<350	3.2%	3.2%	7.7%

CONCLUSIONS: HIV related clinical events were rare in patients who maintained VL <50. Also in VL suppressed patients, the rate of CD4 decline to <350 is lower and total time with CD4 <350 less, than in those experiencing VL >400. These data suggest that reduced frequency of CD4 monitoring in patients who maintain VL<50 on HAART and have achieved good CD4 recovery (>350) may be clinically acceptable.

2008-04-23
O21

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