Is it still worthwhile to perform quarterly cd4+ t lymphocyte cell counts on hiv-1 infected stable patients?
| Autor: | Davide Sirello, Enrico Di Bella, Antonio Di Biagio, Marta Ameri, Marcello Montefiori, Barbara Giannini, Giovanni Cassola, Mauro Giacomini, Giovanni Cenderello, Lucia Taramasso, Claudio Viscoli |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Cart Adult CD4-Positive T-Lymphocytes Male Multivariate statistics medicine.medical_specialty Monitoring Cost Lymphocyte Value (computer science) HIV Infections Kaplan-Meier Estimate Logistic regression 03 medical and health sciences 0302 clinical medicine Internal medicine Lymphocyte T CD4 Medicine Humans Clinical significance 030212 general & internal medicine Stage (cooking) Lymphocyte T CD4+ Aged Proportional Hazards Models business.industry Coinfection HIV Middle Aged Viral Load 030112 virology Confidence interval CD4 Lymphocyte Count Infectious Diseases medicine.anatomical_structure Logistic Models Lymphocyte T CD4 cost HIV Monitoring Italy Immunology HIV-1 RNA Viral Female business Research Article |
| Zdroj: | BMC Infectious Diseases |
| ISSN: | 1471-2334 |
| Popis: | Background In the last 20 years routine T CD4+ lymphocyte (CD4+) cell count has proved to be a key factor to determine the stage of HIV infection and start or discontinue of prophylaxis for opportunistic infections. However, several studies recently showed that in stable patients on cART a quarterly CD4+ cell count monitoring results in limited (or null) clinical relevance. The research is intended to investigate whether performing quarterly CD4+ cell counts in stable HIV-1 patients is still recommendable and to provide a forecast of the cost saving that could be achieved by reducing CD4+ monitoring in such a category of patients. Methods The study is based on data referring to all HIV-infected patients > 18 years of age being treated at two large infectious diseases units located in the metropolitan area of Genoa, Italy. The probability of CD4+ cell counts dropping below a threshold value set at 350 cells/mm3 is assessed using confidence intervals and Kaplan-Meier survival estimates, whereas multivariate Cox analysis and logistic regression are implemented in order to identify factors associated with CD4+ cell count falls below 350 cells/mm3. Results Statistical analysis reveals that among stable patients the probability of maintaining CD4+ >350 cell/mm3 is more than 98%. Econometric models indicate that HCV co-infection and HIV-RNA values >50 copies/mL in previous examinations are associated with CD4+ falls below 350 cells/mm3. Moreover, results suggest that the cost saving that could be obtained by reducing CD4+ examinations ranges from 33 to 67%. Conclusions Empirical findings shows that patients defined as stable at enrollment are highly unlikely to experience a CD4+ value |
| Databáze: | OpenAIRE |
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