Prognostic value of plasma HIV RNA in the natural history of Pneumocystis carinii pneumonia, cytomegalovirus and Mycobacterium avium complex. Multicenter AIDS Cohort Study.
OBJECTIVE
To use follow-up on untreated HIV-positive men to assess the prognostic information provided by baseline data on plasma HIV RNA, CD4 cell count, age, and HIV-related symptom status, separately for three specific AIDS-defining illnesses: Pneumocystis carinii pneumonia (PCP), cytomegalovirus (CMV), and Mycobacterium avium complex (MAC).


METHODS
The study population were 734 HIV-positive homosexual men enrolled in the Multicenter AIDS Cohort Study, with follow-up (1984-1985 through mid-1988) restricted to the antiretroviral treatment-free and prophylaxis-free era. Baseline marker values were categorized and assessed as predictor variables in separate time-to-event analyses for each of the three specific outcomes.


RESULTS
A total of 138 cases of PCP, 25 cases of CMV, and 25 cases of MAC were observed. For PCP and CMV, higher categories of HIV RNA and lower categories of CD4 cell count were associated with increased risk relative to the respective reference groups. For MAC, oral candidiasis or fever and elevated HIV RNA at baseline were the primary risk factors. Further analysis highlighted the importance of monitoring HIV RNA levels in addition to CD4 cell counts when evaluating patients' risk of developing PCP.


CONCLUSIONS
In the absence of treatment, plasma HIV RNA levels provide prognostic information about the risk of these three specific AIDS-defining illnesses, independently of the CD4 cell count. These data provide a useful reference as researchers investigate changing patterns in the incidence and predictors of opportunistic infections in the era of increasingly active antiretroviral therapies.
Lyles
R H
RH
Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205, USA.
Chu
C
C
Mellors
J W
JW
Margolick
J B
JB
Detels
R
R
Giorgi
J V
JV
Al-Shboul
Q
Q
Phair
J P
JP
D017088:AIDS-Related Opportunistic Infections / Q000503:physiopathology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000503:physiopathology; D018450:Disease Progression; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000503:physiopathology*; D006801:Humans; D008297:Male; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000503:physiopathology; D011020:Pneumonia, Pneumocystis / Q000503:physiopathology; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood*; D012044:Regression Analysis; D012307:Risk Factors; D019562:Viral Load; D014766:Viremia / Q000821:virology
D012367:RNA, Viral