Share Abstract
Is CD4 percentage a better marker of immune-suppression than CD4 absolute count in HIV-infected subjects with cirrhosis?
Abstract Content:
Objectives: The relative prognostic value of CD4 percentage and absolute count to predict AIDS-events has not been evaluated in HIV-infected, cirrhotic subjects.
Methods: We evaluated the incidence of AIDS-events in subjects with and without cirrhosis or liver disease in an Italian cohort of HIV-positive, antiretroviral-naive subjects (I.Co.N.A.). Three groups were identified: Group-1, subjects with cirrhosis (histological and/or clinical); Group-2, HCV and/or HBV co-infected subjects without cirrhosis; Group-3, subjects without liver diseases (HCV and HBV-negative, ALT<40 IU/L). The incidences of new AIDS-events and the relative prognostic values of CD4 percentage and absolute count were evaluated by Poisson regression model.
Results: 6,126 subjects were studied (30% females, median age 35 years); CD4 count and percentage at enrolment were 427 (1-1361) and 23% (1%-81%); HIV-RNA was 4.3 log10 copies/mL (1.3-6.8). The prevalence of HCV-Ab and HBsAg positive subjects was 38% and 5%. 402 new AIDS-events were reported during 25,693 PYFU from the date of enrolment to AIDS diagnosis or to last available clinical follow-up (incidence: 1.6x100 PYFU, 95% CI:1.4-1.7). In cirrhotic subjects, higher CD4 cells but not higher percentages were associated with a lower risk of AIDS (RR:0.58, 95% CI:0.39-0.85, p=0.006 per 100 cells/mm3 higher; RR:0.61, 95% CI:0.30-1.24, p=0.17 per 10% higher). In Group-2 and Group-3 both absolute CD4 number and percentage were associated with a higher risk of AIDS (Group-2, RR:0.75, 95% CI:0.67-0.83, p=0.0001 per 100 cells/mm3 higher; RR:0.54, 95% CI:0.43-0.67, p=0.0001 per 10% higher; Group-3, RR:0.52, 95% CI:0.42-0.63, p=0.0001 per 100 cells/mm3 higher; RR:0.61, 95% CI:0.43-0.87, p=0.006 per 10% higher).
Conclusions: Our data indicate that the absolute number of CD4 cells is a better predictor of AIDS-events than CD4 percentage in HIV-infected patients with cirrhosis but not in those with HBV and/or HCV co-infection or without liver disease. Absolute CD4 counts remain the better parameter to be consider to start HAART in this population.
Methods: We evaluated the incidence of AIDS-events in subjects with and without cirrhosis or liver disease in an Italian cohort of HIV-positive, antiretroviral-naive subjects (I.Co.N.A.). Three groups were identified: Group-1, subjects with cirrhosis (histological and/or clinical); Group-2, HCV and/or HBV co-infected subjects without cirrhosis; Group-3, subjects without liver diseases (HCV and HBV-negative, ALT<40 IU/L). The incidences of new AIDS-events and the relative prognostic values of CD4 percentage and absolute count were evaluated by Poisson regression model.
Results: 6,126 subjects were studied (30% females, median age 35 years); CD4 count and percentage at enrolment were 427 (1-1361) and 23% (1%-81%); HIV-RNA was 4.3 log10 copies/mL (1.3-6.8). The prevalence of HCV-Ab and HBsAg positive subjects was 38% and 5%. 402 new AIDS-events were reported during 25,693 PYFU from the date of enrolment to AIDS diagnosis or to last available clinical follow-up (incidence: 1.6x100 PYFU, 95% CI:1.4-1.7). In cirrhotic subjects, higher CD4 cells but not higher percentages were associated with a lower risk of AIDS (RR:0.58, 95% CI:0.39-0.85, p=0.006 per 100 cells/mm3 higher; RR:0.61, 95% CI:0.30-1.24, p=0.17 per 10% higher). In Group-2 and Group-3 both absolute CD4 number and percentage were associated with a higher risk of AIDS (Group-2, RR:0.75, 95% CI:0.67-0.83, p=0.0001 per 100 cells/mm3 higher; RR:0.54, 95% CI:0.43-0.67, p=0.0001 per 10% higher; Group-3, RR:0.52, 95% CI:0.42-0.63, p=0.0001 per 100 cells/mm3 higher; RR:0.61, 95% CI:0.43-0.87, p=0.006 per 10% higher).
Conclusions: Our data indicate that the absolute number of CD4 cells is a better predictor of AIDS-events than CD4 percentage in HIV-infected patients with cirrhosis but not in those with HBV and/or HCV co-infection or without liver disease. Absolute CD4 counts remain the better parameter to be consider to start HAART in this population.