The future role of CD4 cell count for monitoring antiretroviral therapy.
The Lancet Infectious Diseases, February 2015 - For more than two decades, CD4 cell count measurements have been central to understanding HIV disease progression, making important clinical decisions, and monitoring the response to antiretroviral therapy (ART). In well resourced settings, the monitoring of patients on ART has been supported by routine virological monitoring. A recent study put this routine monitoring into question.
Viral load monitoring was recommended by WHO in 2013 guidelines as the preferred way to monitor people on ART, and eff orts are underway to scale up access in resource-limited settings. Recent studies suggest that in situations where viral load is available and patients are virologically suppressed, long-term CD4 monitoring adds little value and stopping CD4 monitoring will have major cost savings.
CD4 cell counts will continue to play an important part in initial decisions around ART initiation and clinical management, particularly for patients presenting late to care, and for treatment monitoring where viral load monitoring is restricted. However, in settings where both CD4 cell counts and viral load testing are routinely available, countries should consider reducing the frequency of CD4 cell counts or not doing routine CD4 monitoring for patients who are stable on ART. (The Lancet Infectious Diseases, volume 15, Issue 2, Pages 131-248)