title: The relative value of CD4 cell count and quantitative HIV-1 RNA in predicting survival in HIV-1-infected women: results of the women's interagency HIV study.
abstract: OBJECTIVE
  To determine factors associated with survival and to assess the relative strength of CD4 cell count and HIV-1 RNA in predicting survival in a cohort of HIV-1-infected women.
  
  
  METHODS
  Prospective cohort, enrolled during 1994-1995, with median follow-up of 29 months
  
  
  RESULTS
  Of 1769 HIV-infected women 252 died. In multivariate analyses, lower CD4 cell count, higher quantitative plasma HIV-1 RNA, and the presence of a self-reported AIDS-defining (Class C) condition were significantly associated with shorter survival: the relative hazard (RH) of dying was 1.17, 3.27, and 8.46, respectively for women with baseline CD4 cell count of 200-349, 50-199, and < 50 x 10(6) cells/l, compared with women with CD4 cell count of > or = 350 x 10(6) cells/l. Compared with women with HIV-1 RNA levels of < 4000 copies/ml plasma, the RH of dying for women with baseline quantitative HIV-1 RNA measurements of 4000-20,000, 20,000-100,000, 100,000-500,000 and > 500,000 copies/ml, was 2.19, 2.17, 3.16, and 7.25, respectively. CD4 cell count had as strong a prognostic value as HIV-1 RNA level, particularly among participants with more advanced immunodeficiency. When the analysis was adjusted to eliminate the distortion created by having disproportionately sized strata of the categorized variables, the relative hazard of death associated with CD4 cell count became even larger in comparison with that for HIV-1 RNA. Eliminating from the analysis all follow-up time during which participants could have received highly active antiretroviral therapy did not change these findings. Age was not a predictor of survival after adjustment for covariates.
  
  
  CONCLUSIONS
  CD4 cell count and HIV-1 RNA had similar prognostic value in this cohort of HIV-1-infected women. Even in the presence of a low viral burden, a substantially decreased CD4 cell count remained a strong predictor of mortality.
authors.affiliation: Montefiore Medical Center, Bronx, New York, USA.
authors.forename: K
authors.initials: K
authors.lastname: Anastos
authors.forename: L A
authors.initials: LA
authors.lastname: Kalish
authors.forename: N
authors.initials: N
authors.lastname: Hessol
authors.forename: B
authors.initials: B
authors.lastname: Weiser
authors.forename: S
authors.initials: S
authors.lastname: Melnick
authors.forename: D
authors.initials: D
authors.lastname: Burns
authors.forename: R
authors.initials: R
authors.lastname: Delapenha
authors.forename: J
authors.initials: J
authors.lastname: DeHovitz
authors.forename: M
authors.initials: M
authors.lastname: Cohen
authors.forename: W
authors.initials: W
authors.lastname: Meyer
authors.forename: J
authors.initials: J
authors.lastname: Bremer
authors.forename: A
authors.initials: A
authors.lastname: Kovacs
mesh_terms: D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000276:immunology / Q000401:mortality* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D015996:Survival Rate
chemical_list: D012367:RNA, Viral