A CD4-cell decline of 30% or more despite viral suppression with antiretroviral therapy (ART) was associated with newly diagnosed cardiovascular disease and cancer, and with death, in a nationwide study in Denmark.
In some antiretroviral-treated people, the CD4 count falls even though treatment controls HIV replication. The clinical consequences of such declines remain poorly defined.
To address this question, researchers in Denmark checked records of the Danish nationwide population-based cohort for 1995 through 2010. The cohort includes everyone in care for HIV infection in Denmark. During the study period, cohort members had their CD4 count measured every 3 months. The researchers used Poisson regression analysis to explore potential associations between a 30% or greater CD4 count fall and cardiovascular disease, cancer, or death.
The analysis included 2584 virally suppressed people followed for a median of 4.7 years. During that time, 56 of these 2584 (2%) had at least a 30% drop in their CD4 count, for an incidence of 4.2 per 1000 person-years (95% confidence interval [CI] 3.2 to 5.4).
In these people the median CD4 count fell from 492 to 240 cells/µL. CD8, CD3, and total lymphocyte counts also fell. Treatment with didanosine was the only HIV-related factor associated with a falling CD4 count.
Regression analysis determined that people with a 30% or greater CD4 decline despite viral suppression had a sharply increased risk of cardiovascular disease within 6 months of their CD4 drop (incidence rate ratio, 11.7, 95% CI 3.6 to 37.4) compared with people who did not lose that many CD4 cells.