May 01, 2013
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CD4 decline linked to cancer, CVD in virally suppressed patients

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A major decline in CD4 count may be a marker of cardiovascular disease or cancer among patients with virally suppressed HIV, researchers from Denmark have found.

“A CD4 decline may reflect a selective loss of CD4 cells, which is usually the case when the CD4 decline is HIV-related and concomitant viral rebound is observed,” the researchers wrote in Clinical Infectious Diseases. “Alternatively, a decline in CD4 count can be caused by factors not related to HIV and is then often a decline in total lymphocyte count with a stable CD4/CD8 ratio.”

Because declines in total lymphocyte counts are associated with certain types of cardiovascular disease (CVD) and with adverse prognosis in cancer, the researchers evaluated whether a CD4 decline was a marker of these diseases. The population-based cohort study included 2,584 patients who achieved viral suppression and had at least five CD4 measurements more than 2 months apart. CD4 decline was defined as at least two consecutive declines of at least 15%.

Fifty-six of the patients experienced CD4 declines, with an incidence rate of 4.2 per 1,000 person-years (95% CI, 3.2-5.4). All patients had a coinciding decline in lymphocytes and CD3 count. Among these patients, the risk for CVD, cancer and death increased less than 6 months after CD4 decline — the incidence rate ratios were 11.7 (95% CI, 3.6-37.4), 13.7 (95% CI, 4.3-43.6) and 4.3 (95% CI, 1.1-17.6), respectively.

“The association between CD4 decline and adverse prognosis may not be specific for HIV-infected individuals and analysis of changes in total lymphocyte counts may reveal similar associations,” the researchers wrote. “This could be explored in other populations that have regular monitoring of lymphocyte counts.”

Disclosure: The researchers report no relevant financial disclosures.