The relative prognostic value of plasma HIV RNA levels and CD4 lymphocyte counts in advanced HIV infection. NLM AIDSLINE Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

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The relative prognostic value of plasma HIV RNA levels and CD4 lymphocyte counts in advanced HIV infection.

AIDS. 1998 Sep 10;12(13):1639-43. Unique Identifier : AIDSLINE MED/98435812
Cozzi Lepri A; Katzenstein TL; Ullum H; Phillips AN; Skinhoj P; Gerstoft J; Pedersen BK; Royal Free Centre for HIV Medicine & Department of Primary Care; and Population Sciences, Royal Free and University College; Medical School, University College London, UK.

Abstract: OBJECTIVE: It has been suggested that the plasma HIV RNA level is a better predictor of AIDS and death than the CD4 lymphocyte count. We assessed whether the prognostic value of plasma virus levels was different according to the CD4 count. DESIGN: Prospective cohort study of HIV-infected patients followed for a median of 2.91 years (range, 0.02-4.54). SETTING: Department of Infectious Diseases at Rigshospitalet, Copenhagen, Denmark. PARTICIPANTS: A group of 255 HIV-infected individuals with an initial measurement of CD4 lymphocyte count and plasma HIV RNA. MAIN OUTCOME MEASURE: Survival time. RESULTS: The plasma HIV RNA (median 101410 copies/ml; range (range 200-7200000) and the CD4 lymphocyte count (median 250 cells x 10(6)/l; range 1-1247) were negatively correlated (Pearson r = -0.53; P < 0.00001). Of the 255 patients, 110 died during follow-up. Overall, a higher HIV RNA level was associated with increased risk of death, but the association was smaller in patients with lower CD4 lymphocyte counts (test for interaction P < 0.0001). In patients with CD4 count below 50 cells x 10(6)/l the association between HIV RNA and risk of death was not statistically significant (relative hazard per 10-fold higher HIV RNA level was 1.53; P = 0.11; adjusted for age and CD4 count) while that between the CD4 count and risk of death was highly significant (relative hazard per 50% lower CD4 count 1.38; P = 0.005; adjusted for age and HIV RNA level). CONCLUSIONS: Patients were relatively lightly treated with antiretroviral drugs both before and during this study. In this situation, it appears that the HIV RNA level has a relatively weak association with risk of death in patients with advanced HIV infection and that the CD4 lymphocyte count is probably more useful in assessing prognosis.
Keywords: JOURNAL ARTICLE Adult Aged Biological Markers Cohort Studies CD4 Lymphocyte Count Female Follow-Up Studies Human HIV/*GENETICS HIV Infections/IMMUNOLOGY/*PHYSIOPATHOLOGY Male Middle Age Prognosis Proportional Hazards Models RNA, Viral/BLOOD Support, Non-U.S. Gov't *Viral LoadKWDjournalarticleadultagedbiologicalmarkerscohortstudiescd4lymphocytecountfemalefollow-upstudieshumanhiv/KWDgeneticshivinfections/immunology/KWDphysiopathologymalemiddleageprognosisproportionalhazardsmodelsrna,viral/bloodsupport,non-uKWDsKWDgov'tKWDviralload
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Copyright © 1999 - National Library of Medicine. Reproduced under license with the National Library of Medicine, Bethesda, MD.

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