Ford Nathan, Stinson Kathryn, Gale Howard, Mills Edward J, Stevens Wendy, Pérez González Mercedes, Markby Jessica, Hill Andrew
Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa;
J Int AIDS Soc. 2015 Aug 7;18(1):20061. doi: 10.7448/IAS.18.1.20061. eCollection 2015.
The effectiveness of antiretroviral therapy (ART) is assessed by measuring CD4 cell counts and viral load. Recent studies have questioned the added value of routine CD4 cell count measures in patients who are virologically suppressed.
We systematically searched three databases and two conference sites up to 31 October 2014 for studies reporting CD4 changes among patients who were on ART and virologically suppressed. No geographic, language or age restrictions were applied.
We identified 12 published and 1 unpublished study reporting CD4 changes among 20,297 virologically suppressed patients. The pooled proportion of patients who experienced an unexplained, confirmed CD4 decline was 0.4% (95% CI 0.2-0.6%). Results were not influenced by duration of follow-up, age, study design or region of economic development. No studies described clinical adverse events among virologically suppressed patients who experienced CD4 declines.
The findings of this review support reducing or stopping routine CD4 monitoring for patients who are immunologically stable on ART in settings where routine viral load monitoring is provided.
抗逆转录病毒疗法（ART）的有效性通过测量CD4细胞计数和病毒载量来评估。最近的研究对病毒学抑制患者常规CD4细胞计数测量的附加价值提出了质疑。
我们系统检索了截至2014年10月31日的三个数据库和两个会议网站，以查找报告接受抗逆转录病毒治疗且病毒学抑制患者CD4变化的研究。未设置地理、语言或年龄限制。
我们确定了12项已发表和1项未发表的研究，报告了20297例病毒学抑制患者的CD4变化。经历无法解释的、确诊的CD4下降的患者合并比例为0.4%（95%置信区间0.2 - 0.6%）。结果不受随访时间、年龄、研究设计或经济发展地区的影响。没有研究描述经历CD4下降的病毒学抑制患者的临床不良事件。
本综述的结果支持在提供常规病毒载量监测的情况下，减少或停止对接受抗逆转录病毒治疗且免疫稳定患者的常规CD4监测。
