The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

CD4 Count and the Risk for Death in Patients Infected with HIV Receiving Antiretroviral Therapy

Robert Yarchoan, MD; David J. Venzon, PhD; James M. Pluda, MD; Jill Lietzau, BSN; Kathleen M. Wyvill, BSN; Anastasios A. Tsiatis, PhD; Seth M. Steinberg, PhD; and Samuel Broder, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by grant AI-24643 from the NIH and the National Institute of Allergy and Infectious Diseases.

Requests for Reprints: Robert Yarchoan, MD, National Cancer Institute, Building 10, Room 13N248, National Institutes of Health, Bethesda, MD 20892.

Current Author Addresses: Drs. Yarchoan, Venzon, Pluda, Steinberg, and Broder and Mrs. Lietzau and Mrs. Wyvill: National Cancer Institute, Building 10, National Institutes of Health, Bethesda, MD 20892.

Dr. Tsiatis: SDAC, Division of Biostatistics and Epidemiology, Dana Farber Cancer Institute, 44 Binney Street, Boston, MA 02115.

Ann Intern Med. 1991;115(3):184-189. doi:10.7326/0003-4819-115-3-184
Text Size: A A A

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 longterm 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 < 10-10). The hazard of dying in the cohort ranged from 0 deaths/patient-month (95% Cl, 0 to 0.008 deaths/ patient-month) in patients with 200 or more CD4 cells/ mm3 to 0.07 deaths/patient-month (Cl, 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 (Cl, 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 (Cl, 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.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.