Absolute Count and Percentage of CD4+Lymphocytes Are Independent Predictors of Disease Progression in HIV‐Infected Persons Initiating Highly Active Antiretroviral Therapy

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Abstract
Background. Highly active antiretroviral therapy (HAART) is recommended when the absolute CD4+ T lymphocyte count is 3, and it should be considered when that count is ≥200, although the optimal timing when it is ≥200 is unclear. Because preliminary data had suggested that a low CD4+ T lymphocyte percentage (%CD4) is associated with disease progression in persons initiating HAART who have a higher absolute CD4, we sought to further characterize the predictive utility of %CD4. Methods. We conducted an observational study of persons in Collaborations in HIV Outcomes Research/US cohort who initiated their first HAART regimen between 1997 and 2004, received ≥30 days of therapy, and had baseline values of absolute CD4, %CD4, and HIV-1 RNA. Cox proportional-hazards models determined associations between %CD4 and disease progression (to either a new AIDS-defining event [ADE] or death). Results. Of 1891 persons, 11% were female and 18% were African American; the median age was 38 years. Median follow-up was 55 months (interquartile range, 23–83 months), and 468 (25%) had disease progression. Multivariable analysis including age, race, sex, HIV-1 RNA, prior antiretroviral therapy, probable route of infection, prior ADE, absolute CD4, and %CD4 was performed; prior ART (P<.0001), injection-drug use (P=.04), lower absolute CD4 (P=.002), and lower %CD4 (P=.002) predicted disease progression. Conclusions. %CD4 at initiation of the first HAART regimen predicted disease progression independent of absolute CD4; %CD4 may be used to determine the timing of HAART.

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