SURVIVAL AFTER A VERY-LOW (LESS-THAN-5X10(6) L) CD4+ T-CELL COUNT IN INDIVIDUALS INFECTED WITH HIV/

Objective: To describe survival after a CD4+ T-cell count of less than 5 x 10(6)/l and to identify possible baseline factors associated with outcome. Design: A prospective cohort study. Setting: A large teachin g hospital in North London. Patients and participants: Patients treate d at the Royal Free Hospital, London, who had at least one reported CD 4+ T-cell count of less than 5 x 10(6)/l and were being followed up fo r clinical care prior to the date of this cell count. Main outcome mea sure: Death. Methods: Proportional hazards models, Kaplan-Meier analys is. Results: One-hundred and sixty-nine patients were included in the study. The median survival after a very low CD4+ T-cell count was 0.95 years (95% confidence interval, 0.78-1.19), although 20% survived for over 2 years. Older age and a previous AIDS diagnosis were related to poorer outcome. A higher CD8+ T-cell count at baseline was also assoc iated with a better prognosis. Conclusions: A CD4+ T-cell count of les s than 5 x 10(6)/l did not necessarily mean imminent death, with a med ian survival after this count of just under 1 year. These results will enable clinicians to provide appropriate counselling for patients at this late stage and to plan terminal care.