Is it still worthwhile to perform quarterly CD4+ T lymphocyte cell counts on HIV-1 infected stable patients?

Background: In the last twenty years routine T CD4+ lymphocyte (CD4) cell count has proved to be a key factor to determine the stage of HIV infection and start or discontinue of prophylaxis for opportunistic infections. However, several studies recently showed that in stable patients on cART a quarterly CD4 cell count monitoring results in limited (or null) clinical relevance. The research is intended to investigate whether performing quarterly CD4 cell counts in stable HIV-1 patients is still recommendable and to provide a forecast of the cost saving that could be achieved by reducing CD4 monitoring in such a category of patients. Methods: The study is based on data referring to all HIV-infected patients > 18 years of age being treated at two infectious diseases units located in the metropolitan area of Genoa, Italy. The probability of CD4 cell counts dropping below a threshold value set at 350 cells/mm3 is assessed using confidence intervals and Kaplan-Meier survival estimates, whereas multivariate Cox analysis and logistic regression are implemented in order to identify factors associated with CD4 cell count falls below 350 cells/mm3. Results: Statistical analysis reveals that among stable patients the probability of maintaining CD4 >350 cell/mm3 is more than 98%. Econometric models indicate that HCV co-infection and HIV-RNA values >50 copies/mL in previous examinations are associated with CD4 falls below 350 cells/mm3. Moreover, results suggest that the cost saving that could be obtained by reducing CD4 examinations ranges from 33% to 67%. Conclusions: Empirical findings show that patients defined as stable at enrollment are highly unlikely to experience a CD4 value <350 cell/mm3 in the space/arc of a year. The research supports a recommendation for annual CD4 monitoring in stable HIV-1 patients.