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Lancet Infect Dis. 2015 Feb;15(2):241-7. doi: 10.1016/S1473-3099(14)70896-5. Epub 2014 Nov 19.

The future role of CD4 cell count for monitoring antiretroviral therapy.

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Department of HIV/AIDS, World Health Organization, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa. Electronic address:
Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Chelsea and Westminster Hospital, London, UK.
Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa.
Department of Pharmacology and Therapeutics, Liverpool University, UK.
Clinton Health Access Initiative, Boston, MA, USA.
Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
Fundação Oswaldo Cruz, Ministry of Health, Brazil.
HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland.
YRG Centre for AIDS Research and Education, Chennai, India.
Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Institut de Recherche pour le Développement (IRD), Montpellier, France.
Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
Department of Molecular Medicine and Haematology, University of the Witwatersrand and National health Laboratory Services, Johannesburg, South Africa.
Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, Rockville, USA.


For more than two decades, CD4 cell count measurements have been central to understanding HIV disease progression, making important clinical decisions, and monitoring the response to antiretroviral therapy (ART). In well resourced settings, the monitoring of patients on ART has been supported by routine virological monitoring. Viral load monitoring was recommended by WHO in 2013 guidelines as the preferred way to monitor people on ART, and efforts are underway to scale up access in resource-limited settings. Recent studies suggest that in situations where viral load is available and patients are virologically suppressed, long-term CD4 monitoring adds little value and stopping CD4 monitoring will have major cost savings. CD4 cell counts will continue to play an important part in initial decisions around ART initiation and clinical management, particularly for patients presenting late to care, and for treatment monitoring where viral load monitoring is restricted. However, in settings where both CD4 cell counts and viral load testing are routinely available, countries should consider reducing the frequency of CD4 cell counts or not doing routine CD4 monitoring for patients who are stable on ART.

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