Development and validation of decision rules to guide frequency of monitoring CD4 cell count in HIV-1 infection before starting antiretroviral therapy

Although CD4 cell count monitoring is used to decide when to start antiretroviral therapy in patients with HIV-1 infection, there are no evidence-based recommendations regarding its optimal frequency. It is common practice to monitor every 3 to 6 months, often coupled with viral load monitoring. We...

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Published in:PloS one 2011-04, Vol.6 (4), p.e18578
Main Authors: Buclin, Thierry, Telenti, Amalio, Perera, Rafael, Csajka, Chantal, Furrer, Hansjakob, Aronson, Jeffrey K, Glasziou, Paul P
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
AIDS
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antiretroviral Therapy, Highly Active
Biomarkers
Care and treatment
CD4 antigen
CD4 Lymphocyte Count - methods
Cohort analysis
Cohort Studies
Computer simulation
Decision Making
Drug therapy
Ethnicity
Evidence-based medicine
Health aspects
Health Planning Guidelines
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - drug therapy
HIV Infections - immunology
HIV Infections - virology
HIV patients
HIV-1 - immunology
Hospitals
Human immunodeficiency virus
Humans
Infections
Literature reviews
Medicine
Monitoring
Nomograms
Patients
Primary care
Random variables
Reproducibility of Results
Sensitivity and Specificity
Shot
Studies
Therapy
Thresholds
Toxicology
Trajectory analysis
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cited_by cdi_FETCH-LOGICAL-c691t-863e2b634ff38c96aff6c181f86c15c52c54dd8c7641968ea1c558baeb3ad5f73
cites cdi_FETCH-LOGICAL-c691t-863e2b634ff38c96aff6c181f86c15c52c54dd8c7641968ea1c558baeb3ad5f73
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container_start_page e18578
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creator Buclin, Thierry
Telenti, Amalio
Perera, Rafael
Csajka, Chantal
Furrer, Hansjakob
Aronson, Jeffrey K
Glasziou, Paul P
description Although CD4 cell count monitoring is used to decide when to start antiretroviral therapy in patients with HIV-1 infection, there are no evidence-based recommendations regarding its optimal frequency. It is common practice to monitor every 3 to 6 months, often coupled with viral load monitoring. We developed rules to guide frequency of CD4 cell count monitoring in HIV infection before starting antiretroviral therapy, which we validated retrospectively in patients from the Swiss HIV Cohort Study. We built up two prediction rules ("Snap-shot rule" for a single sample and "Track-shot rule" for multiple determinations) based on a systematic review of published longitudinal analyses of CD4 cell count trajectories. We applied the rules in 2608 untreated patients to classify their 18 061 CD4 counts as either justifiable or superfluous, according to their prior ≥5% or 650 for a threshold of 200, >900 for 350, or >1150 for 500×10(6)/L, respectively. When CD4 counts fall below these limits, increased monitoring frequency becomes advisable. These rules offer guidance for efficient CD4 monitoring, particularly in resource-limited settings.
doi_str_mv 10.1371/journal.pone.0018578
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source Publicly Available Content Database; PubMed Central
subjects Acquired immune deficiency syndrome
AIDS
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antiretroviral Therapy, Highly Active
Biomarkers
Care and treatment
CD4 antigen
CD4 Lymphocyte Count - methods
Cohort analysis
Cohort Studies
Computer simulation
Decision Making
Drug therapy
Ethnicity
Evidence-based medicine
Health aspects
Health Planning Guidelines
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - drug therapy
HIV Infections - immunology
HIV Infections - virology
HIV patients
HIV-1 - immunology
Hospitals
Human immunodeficiency virus
Humans
Infections
Literature reviews
Medicine
Monitoring
Nomograms
Patients
Primary care
Random variables
Reproducibility of Results
Sensitivity and Specificity
Shot
Studies
Therapy
Thresholds
Toxicology
Trajectory analysis
title Development and validation of decision rules to guide frequency of monitoring CD4 cell count in HIV-1 infection before starting antiretroviral therapy
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