Lack of consistency between five definitions of nonprogression in cohorts of HIV-infected seroconverters.

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Lack of consistency between five definitions of nonprogression in cohorts of HIV-infected seroconverters.

AIDS. 1996 Aug;10(9):959-65. Unique Identifier : AIDSLINE MED/97006435
Strathdee SA; Veugelers PJ; Page-Shafer KA; McNulty A; Moss AR; Schechter MT; van Griensven GJ; Coutinho RA; Department of Health Care and Epidemiology, University of British; Columbia, St Paul's Hospital, Vancouver, Canada.

Abstract: OBJECTIVE: To identify appropriate criteria for characterizing HIV-infected nonprogressors. DESIGN: Five definitions were compared as follows: (1) last CD4 count > 500 x 10(6)/l; (2) two most recent CD4 counts > 500 x 10(6)/l; (3) calculated CD4 count based on linear regression > 500 x 10(6)/l; (4) CD4 slope > or = 0 with no antiretroviral use; (5) all CD4 counts > 500 x 10(6)/l, decline in CD4 slope < 5 cells per year, no antiretroviral use. PARTICIPANTS: Five prospective cohorts of homosexual men with documented dates of HIV-1 seroconversion. MAIN OUTCOME MEASURES: Proportions of nonprogressors were calculated 7, 8, 9 and 10 years following seroconversion (n = 285). Definitions were evaluated with respect to consistency over time and across sites. Subjects lacking CD4 counts within 3 years preceding end of follow-up were excluded. RESULTS: Across sites, proportions of nonprogressors ranged from 1% (definition 5) to 17.5% (definition 1) 10 years after seroconversion. Definitions based on absolute CD4 counts (definitions 1-3) had higher proportions and were less consistent than those based on stable slopes (definitions 4 and 5). For each definition, proportions decreased as follow-up increased, but were most stable for definition 4 (3%). Site differences decreased as follow-up increased, but remained nearly threefold for definitions 1-3. None of the definitions classified the same subjects as nonprogressors at any timepoint. CONCLUSIONS: Observations regarding nonprogression are highly dependent on the definition and the duration of follow-up. Our findings highlight methodological challenges which will need to be overcome in natural history studies of nonprogression.

Keywords: Cohort Studies CD4-Positive T-Lymphocytes/*PATHOLOGY Homosexuality, Male Human HIV Infections/PATHOLOGY/*PHYSIOPATHOLOGY Lymphocyte Count Male Prognosis Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. JOURNAL ARTICLE
970330
M9731504

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