CD4 Trajectory Models and Onset of Non–AIDS-Defining Anal Genital Warts, Precancer, and Cancer in People Living With HIV Infection-1. Issue 9 (September 2020)

• Record Type: Journal Article
• Authors: Ye, Yuanfan; Burkholder, Greer A.; Wiener, Howard W.; Aslibekyan, Stella; Khan, Ashraf; Shrestha, Sadeep
• Is Part Of: Sexually transmitted diseases. Volume 47:Issue 9(2020)
• Publication Date: 2020-09
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000001215
• Languages: English
• ISSNs: 0148-5717

Abstract

Abstract : Background: It is unclear how the characteristics of CD4 counts predict non–AIDS-defining human papillomavirus–related anogenital warts (AGWs) and anal high-grade squamous intraepithelial lesions/cancer (HSIL + ) in people living with HIV infection-1 (PLWH). We compared the associations between 3 CD4 counts measures and these disease outcomes in the study. Methods: Retrospective sociobehavioral and clinical data from electronic health records of 4803 PLWH from 2006 to 2018 were included. Three different measurements of CD4 counts—( a ) nadir, ( b ) median, and ( c ) trajectory—were estimated. Six CD4 trajectory groups were constructed using the group-based trajectory modeling from all patients older than 18 years with ≥3 clinical visits. Univariate and multivariable logistic regression models were used to assess the associations with AGW and HSIL +, separately. Results: A total of 408 AGW, 102 anal HSIL + (43 HSIL, 59 cancer), 4 penile cancer, and 15 vaginal cancer cases were observed. Median CD4 (<200 cell/μL) was associated with AGW (odds ratio [OR], 2.2 [95% confidence interval {CI}, 1.6–3.0]), and anal HSIL + (OR, 2.7 [95% CI, 1.5–5.0]; each, P < 0.001). Low nadir CD4 (<200 cell/μL) was associated with AGW (OR, 1.8 [95% CI, 1.3–2.6]) and anal HSIL + (OR, 2.4 [95% CI, 1.2–4.7]; each, P ⩽ 0.001). Different patterns (declining and sustained low CD4 counts) of CD4 trajectories showed the strongest associations with onset of both AGW (OR, 1.8–3.1) and HSIL + (OR, 2.7–6.7). Conclusions: People living with HIV infection-1 with the same median CD4 could have very different CD4 trajectories, implying different dynamics of immune status. CD4 trajectory could be a better predictor of incident AGW and HSIL + among PLWH. Abstract : Using single CD4 measure to predict the onset of comorbidities among people living with HIV infection-1 is common, but incorporating longitudinal CD4 measures in risk assessments may be more precise and informative.