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Clinical Trial
. 1991 Aug 1;115(3):184-9.
doi: 10.7326/0003-4819-115-3-184.

CD4 count and the risk for death in patients infected with HIV receiving antiretroviral therapy

R Yarchoan  1 , D J Venzon, J M Pluda, J Lietzau, K M Wyvill, A A Tsiatis, S M Steinberg, S Broder
Affiliations
Clinical Trial

CD4 count and the risk for death in patients infected with HIV receiving antiretroviral therapy

R Yarchoan et al. Ann Intern Med. .

Abstract

Objective: To investigate the relation between CD4 count and the immediate hazard of dying in patients receiving zidovudine (azidothymidine [AZT])-based antiretroviral therapy.

Setting: A research hospital that recruits patients from the entire United States.

Design: Retrospective analysis of a cohort of patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex participating in long-term zidovudine-based antiretroviral protocols.

Patients: Fifty-five patients with human immunodeficiency virus (HIV) infection and either AIDS or severe AIDS-related complex who were followed for as many as 4 years while they received antiretroviral therapy.

Measurements: CD4 counts were measured.

Main results: Ten patients are known to be alive and 1 was lost to follow-up. Of the 44 patients who are known to have died, the CD4 range was known within 6 months of death in 41. All but 1 of these 41 assessable deaths occurred in patients whose CD4 counts were known to have fallen below 50 CD4 cells/mm3 (P less than 10(-10)). The hazard of dying in the cohort ranged from 0 deaths/patient-month (95% CI, 0 to 0.008 deaths/patient-month) in patients with 200 or more CD4 cells/mm3 to 0.07 deaths/patient-month (CI, 0.050 to 0.094 deaths/patient-month) in patients with fewer than 50 CD4 cells/mm3. For the patients who died and whose cases were assessable, the mean of the last three CD4 counts obtained before death was 7.7 CD4 cells/mm3 (CI, 0.9 to 63.3 cells/mm3). The median survival of patients once their CD4 counts fell below 50 CD4 cells/mm3 was 12.1 months (CI, 7.2 to 19.4 months).

Conclusions: In a carefully followed cohort treated with zidovudine-based antiretroviral therapy, nearly all deaths occurred in patients with fewer than 50 CD4 cells/mm3. These findings may have implications in the monitoring of patients with AIDS and in the use of CD4 count as a clinical trials end point for the antiretroviral therapy of HIV infection.

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Comment in

  • CD4 counts and HIV-related deaths.
    Williams W, Drabick JJ, Tang DB. Williams W, et al. Ann Intern Med. 1992 Jan 15;116(2):168; author reply 169-70. doi: 10.7326/0003-4819-116-2-168. Ann Intern Med. 1992. PMID: 1345773 No abstract available.
  • CD4 counts and HIV-related deaths.
    Flegg PJ, Willocks LJ. Flegg PJ, et al. Ann Intern Med. 1992 Jan 15;116(2):169; author reply 169-70. Ann Intern Med. 1992. PMID: 1345774 No abstract available.

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