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Lower CD4 Count Despite Undetectable Load Raises Risks of AIDS and Death
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XVII International AIDS Conference
August 3-8, 2008
Mexico City
Mark Mascolini
Having a CD4 count that stays under 200 after a potent antiretroviral regimen pushes the viral load below 50 copies heightens risks of AIDS and death, according to a 249-man analysis in the Multicenter AIDS Cohort Study (MACS) [1]. Men whose CD4s languished below the 200 mark despite an undetectable load had almost an 80% higher risk of dying than men whose CD4s climbed to between 200 and 350.
The study involved MACS members with a CD4 count below 200 before starting a potent regimen and with at least one sub-50-copy viral load during treatment. MACS investigators assessed time from first reaching a load below 50 copies and subsequent AIDS or death in an analysis that factored in history of AIDS, antiretroviral experience before a potent regimen, time from starting a potent regimen to first sub-50 load, age at first sub-50 load, and CD4 count when viral load lay below 50 copies.
The 249 MACS men studied had a median age of 43 years, 58% were white, 26% African American, and 15% Hispanic. While one quarter had an AIDS diagnosis before treatment cut their viral load to below 50 copies, 53% had taken suboptimal regimens before starting a potent combination.
Seventeen of the 249 men (7%) got a new AIDS diagnosis after recording their first load under 50 copies, and 25 (10%) died after reaching that goal. Climbing above the 200-cell mark while plasma viremia was undetectable trimmed the odds of both AIDS and death at the following hazard ratios (HR):
- Risk of AIDS 46% lower with 201 to 350 CD4s vs <200: HR 0.54, P = 0.286 (not significant)
- Risk of AIDS 75% lower with >350 CD4s vs <200: HR 0.25, P = 0.038
- Risk of death 78% lower with 201 to 350 CD4s vs <200: HR 0.22, P = 0.004
- Risk of death 91% lower with >350 CD4s vs <200: HR 0.09, P < 0.001
The MACS team believes their findings suggest that treatment goals should emphasize adding CD4 cells as much as getting HIV RNA into an undetectable range. The investigators called for further study of CD4-boosting tactics for people whose counts stay low after they reach an undetectable viral load.
Reference
1. Taiwo B, Palella F, Li X, et al. Higher CD4 counts are independently associated with lower risks of AIDS and death in HIV RNA suppressed HAART users. XVII International AIDS Conference. August 3-8, 2008. Mexico City. Abstract TUPE0090.
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