title: Predictive value of viral load and other markers for progression to clinical AIDS after CD4+ cell count falls below 200/microL. SEROCO & HEMOCO Study Group.
abstract: BACKGROUND
  To assess the predictive value of biological and clinical events for progression to AIDS (1993 European classification) when the CD4+ cell count falls below 200/microL (CD4 threshold) in different exposure groups. To investigate whether such markers remain predictive independently of the serum HIV-1 RNA level at the CD4 threshold.
  
  
  METHODS
  The predictive value of biological and clinical events occurring during the 24 months prior to the occurrence of CD4 threshold (n = 333) was quantified in a Cox model. Another Cox model was carried out in a subset of 77 patients in whom viral load from stored sera was available. Furthermore, changes in viral load during the 24 months preceding the CD4 threshold were assessed in a mixed model according to subsequent development of AIDS.
  
  
  RESULTS
  Among the 333 patients, the slope of the CD4+ cell counts, the emergence of p24 antigen, persistent thrush, and age at the CD4 threshold were independent predictors of progression to clinical AIDS (44.7%). Among the subset of 77 patients, the HIV-1 RNA level at the CD4 threshold, persistent thrush and age remained independent predictors of progression to AIDS (45.5%). The increase of the HIV-1 RNA level was moderate, both in non-progressors (24.0% per year) and in those who subsequently developed AIDS (27.1% per year), (P = 0.93). Viral load was consistently higher in the latter group (P = 0.002).
  
  
  CONCLUSIONS
  At a late stage of infection, age and persistent thrush remain predictive of progression to AIDS, independently of viral load.
authors.affiliation: INSERM U292, Secteur Bleu Pierre-Marié Porte 26, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
authors.forename: N
authors.initials: N
authors.lastname: Carré
authors.forename: F
authors.initials: F
authors.lastname: Boufassa
authors.forename: J B
authors.initials: JB
authors.lastname: Hubert
authors.forename: M
authors.initials: M
authors.lastname: Chavance
authors.forename: C
authors.initials: C
authors.lastname: Rouzioux
authors.forename: C
authors.initials: C
authors.lastname: Goujard
authors.forename: Y
authors.initials: Y
authors.lastname: Laurian
authors.forename: L
authors.initials: L
authors.lastname: Meyer
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000032:analysis; D019562:Viral Load
chemical_list: D012367:RNA, Viral