Relationship between CD4 lymphocyte count and AIDS mortality, 1986–1991

Abstract

Objective To determine the relationship between CD4 lymphocyte count and short-term AIDS mortality, and to determine whether this relationship changed during 1986–1991. Design A retrospective analysis of CD4 lymphocyte counts in patients dying with AIDS and estimation of median survival in patients with a CD4 count < 50 x 10⁶/l. Methods Absolute CD4 lymphocyte count in the 6 months before death was available for 178 patients. The terminal CD4 count was compared in five cohorts of patients dying in 12-month periods from July 1986. Kaplan-Meier survival curves were constructed using survival from date of first absolute CD4 count < 50 $$ 10⁶/l in 271 patients and compared for each yearly cohort. Results The median terminal CD4 lymphocyte count for all patients was 10 $$ 10⁶/l. The median terminal CD4 counts for each yearly cohort were: 1986/1987, 100 (n = 13); 1987–1988, 10 (n = 27); 1988–1989, 10 (n = 30); 1989/1990, 20 (n = 59); 1990–1991, 10 (n = 58). There was a significant difference in the terminal CD4 count in the 1986–1987 period compared with all other years combined, but no further changes after 1987–1988. The median survival of all patients from date of first CD4 count < 50 $$ 10⁶/I was 11.9 months. There was no significant difference in median survival in each yearly cohort. Conclusions There is a close correlation between CD4 lymphocyte count and short-term mortality in AIDS. Therapeutic advances over the past 5 years are not reflected by changes in CD4 count before death or improved survival in patients with very low CD4 counts.