PROGNOSTIC VALUE OF THE CD4-CELL COUNT FOR HIV-1-INFECTED PATIENTS WITH ADVANCED IMMUNOSUPPRESSION( T)

The prognostic value of the CD4+ T cell count is not clearly establish ed for HIV-1 infected patients with an advanced immunosuppression. The aim of this study was to assess the relationship between CT4+ T cell counts and survival in patients with less than 50 CD4+ T cells per mm( 3) (/mm(3)). We examined an historical cohort of 97 patients with 2 co nsecutive CD4+ T cells determinations <50/mm(3) within 3 months, follo wed at a university hospital of the University of Montreal. The propor tion of men was 93% with 74% being home/bisexual. The means of the 2 C D4+ T cell counts/mm(3) were 25 and 25.1 respectively. Median survival after the first CD4+ T cell count <50 CD4+ T cells/mm(3) was 15.2 mon ths. Using the proportional hazard model, the median survival of patie nts with 2 consecutive CD4+ T cell counts less than or equal to 20/mm( 3) was 9.3 months compared to 19.2 for those with 20-50 CD4+ T cells/m m(3) (P<0.0001). It seems then, that the CD4+ T cell count is a helpfu l prognostic marker even in very immunosuppressed patients. Its progno stic value is more accurate if the measurement is repeated within 1-3 months because of high variability at this level of immunosuppression.