When to monitor CD4 cell count and HIV RNA to reduce mortality and AIDS-defining illness in virologically suppressed HIV-positive persons on antiretroviral therapy in high-income countries: A prospective observational study. Journal of Acquired Immune Deficiency Syndromes
Caniglia et al. on behalf of the Center for AIDS Research Network of Integrated Clinical Systems and the HIV-CAUSAL Collaboration estimated the effect of CD4 cell count and HIV RNA monitoring strategies on clinical, virologic, and immunologic outcomes in virologically suppressed HIV-positive patients.
Compared with monitoring every 3 months, the overall mortality hazard ratio was 0.86 for 6 months and 0.82 for 9–12 months. The corresponding hazard ratios for the combined endpoint of AIDS-defining illness or death were 0.76 and 1.06. Compared with monitoring every 3 months, the overall risk ratio for virologic failure (HIV RNA ≥50 copies/mL) was 0.64 for six months and 1.18 for 9–12 months.
In conclusion, the study shows little evidence for an effect of monitoring frequency on death or AIDS-defining illness or death in the short term among individuals who achieve virologic suppression within 12 months of cART initiation. The findings suggest that monitoring every 9–12 months increases the risk of virologic failure compared with monitoring every 3 months.
Commentary Dominique Braun (MD) and Huldrych Günthard (MD)
The authors conclude that there is no evidence for an effect of reducing the monitoring frequency on death or AIDS-defining illnesses. However, one has to realize that the risk for a treatment failure was significantly higher in the 9-12 month monitoring group when compared to the 3 and 6 month groups. For this reason, we strongly suggest to maintain a 3 or at the most a 6 months monitoring interval.