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


METHODS
Prospective cohort study of HIV-infected patients followed for a median of 2.91 years (range, 0.02-4.54).


METHODS
Department of Infectious Diseases at Rigshospitalet, Copenhagen, Denmark.


METHODS
A group of 255 HIV-infected individuals with an initial measurement of CD4 lymphocyte count and plasma HIV RNA.


METHODS
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.
Royal Free Centre for HIV Medicine & Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, UK.
A
A
Cozzi Lepri
T L
TL
Katzenstein
H
H
Ullum
A N
AN
Phillips
P
P
Skinhøj
J
J
Gerstoft
B K
BK
Pedersen
D000328:Adult; D000368:Aged; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000235:genetics*; D015658:HIV Infections / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load
D015415:Biomarkers; D012367:RNA, Viral