SEATTLE — Patients who initiate ART without pretherapy CD4 monitoring experience a higher risk for early mortality than those who are tested, study data presented at CROI suggest.
Kombatende Sikombe , MPH , research manager at the Centers for Infectious Disease Research in Zambia, and colleagues noted that CD4 testing is no longer required in the “treat-all” era, and the practice is being phased out in some places. But CD4 testing “can play a crucial role in informing screening and prophylaxis for opportunistic infections, which are contributors to HIV-related mortality,” they wrote.
“We think that it’s important that patients are screened before initiating ART,” Sikombe said during a news conference. “Currently, the practice is to test and treat all. With this, we are missing some opportunistic infections in patients and we think that perhaps these patients are dying early.”
Using electronic medical records, Sikombe and colleagues assessed the association between presence of a pretherapy CD4 test and early mortality among 39,556 patients in Zambia who initiated ART between August 2013 and July 2015.
Among them, 76% had a record of a pretherapy CD4 test. According to the evaluation, the cumulative incidence of mortality after ART initiation was 5.12% (95% CI, 4.32-6.10). The cumulative incidence of mortality with pretherapy CD4 monitoring at 1 year was 4.54% (95% CI, 3.73-5.60) and it was 7.06% (95% CI, 5.14-9.98) without pretherapy CD4 monitoring.
After adjusting for pretherapy stage, sex, age, facility type and ART initiation date, Sikombe and colleagues found that patients without pretherapy CD4 monitoring had 1.48 times the hazard of mortality in the first year compared with tested patients (95% CI, 1.00-2.17).
“Even in the absence of CD4 monitoring and eligibility determination, there may still be an important role for use of CD4 for risk stratification and clinical management of immunocompromised patients,” Sikombe said. “As the investments in CD4 testing are drawn down, strategies to preserve limited clinical use should be investigated.” – by Caitlyn Stulpin
Sikombe K, et al. Abstract 96. Presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle.
Disclosure: Sikombe reports no relevant financial disclosures.