Ford Nathan, Meintjes Graeme, Vitoria Marco, Greene Greg, Chiller Tom
aDepartment of HIV and Global Hepatitis Programme, World Health Organization, Geneva, Switzerland bDivision of Infectious Diseases and HIV Medicine, Department of Medicine cClinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa dMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Curr Opin HIV AIDS. 2017 Mar;12(2):123-128. doi: 10.1097/COH.0000000000000348.
The role of the CD4 cell count in the management of people living with HIV is once again changing, most notably with a shift away from using CD4 assays to decide when to start antiretroviral therapy (ART). This article reflects on the past, current and future role of CD4 cell count testing in HIV programmes, and the implications for clinicians, programme managers and diagnostics manufacturers.
Following the results of recent randomized trials demonstrating the clinical and public health benefits of starting ART as soon as possible after HIV diagnosis is confirmed, CD4 cell count is no longer recommended as a way to decide when to initiate ART. For patients stable on ART, CD4 cell counts are no longer needed to monitor the response to treatment where HIV viral load testing is available. Nevertheless CD4 remains the best measurement of a patient's immune and clinical status, the risk of opportunistic infections, and supports diagnostic decision-making, particularly for patients with advanced HIV disease.
As countries revise guidelines to provide ART to all people living with HIV and continue to scale up access to viral load, strategic choices will need to be made regarding future investments in CD4 cell count and the appropriate use for clinical disease management.
CD4细胞计数在HIV感染者管理中的作用再次发生变化，最显著的是不再依据CD4检测结果来决定何时开始抗逆转录病毒治疗（ART）。本文回顾了CD4细胞计数检测在HIV项目中的过去、当前及未来作用，以及对临床医生、项目管理者和诊断试剂制造商的影响。
近期随机试验结果表明，在确诊HIV后尽快开始ART具有临床和公共卫生益处，因此不再推荐将CD4细胞计数作为决定何时启动ART的方法。对于接受ART治疗病情稳定的患者，若有HIV病毒载量检测，就不再需要通过CD4细胞计数来监测治疗反应。然而，CD4仍然是衡量患者免疫和临床状态、机会性感染风险的最佳指标，并且有助于诊断决策，特别是对于晚期HIV疾病患者。
随着各国修订指南以便为所有HIV感染者提供ART，并继续扩大病毒载量检测的可及性，需要就未来在CD4细胞计数方面的投资以及临床疾病管理的适当应用做出战略选择。
