title: Plasma RNA viral load predicts the rate of CD4 T cell decline and death in HIV-2-infected patients in West Africa.
abstract: OBJECTIVE
  To examine whether the levels of plasma RNA and DNA provirus predict the rate of CD4 cell decline and patient death.
  
  
  METHODS
  Retrospective analysis of HIV-2 cohort subjects.
  
  
  METHODS
  Fifty-two subjects were recruited between January 1991 and December 1992. HIV-2 RNA levels in plasma and DNA levels in peripheral blood mononuclear cells (PBMC) were measured using in-house quantitative PCR assays. The annual rate of CD4 cell decline was calculated using the least-squares method. The survival data on 31 December 1997 were used.
  
  
  RESULTS
  The mean percentage of CD4 cells at baseline was 30.7 (SD, 9.5). In a linear regression model, the annual rate of CD4 cell decline was 1.76 CD4% faster for every increase in one log10 RNA copies/ml [95% confidence interval (CI), 0.81-2.7; P = 0.0006; r = 0.46; n = 52] and 1.76 CD4% faster for every increase in log10 DNA copies/10(5) PBMC (95% CI 0.46-3.1; P = 0.01; r = 0.33; n = 42). In a multiple linear regression model, RNA load was related to CD4 decline independently of DNA load (P = 0.02). The overall mortality rate was 7.29/100 person-years. In a Cox regression model, the hazard rate increased by 2.12 for each log10 increase in RNA load (95% CI, 1.3-3.5; P = 0.0023) but only by 1.09 for each log10 increase in DNA load (95% CI, 0.64-1.87; P = 0.8).
  
  
  CONCLUSIONS
  This longitudinal study shows for the first time that a baseline HIV-2 RNA load predicts the rate of disease progression. HIV-2-infected patients with a high viral load may need to be treated as vigorously as HIV-1 patients.
authors.affiliation: Medical Research Council Laboratories, The Gambia, West Africa.
authors.forename: K
authors.initials: K
authors.lastname: Ariyoshi
authors.forename: S
authors.initials: S
authors.lastname: Jaffar
authors.forename: A S
authors.initials: AS
authors.lastname: Alabi
authors.forename: N
authors.initials: N
authors.lastname: Berry
authors.forename: M
authors.initials: M
authors.lastname: Schim van der Loeff
authors.forename: S
authors.initials: S
authors.lastname: Sabally
authors.forename: P T
authors.initials: PT
authors.lastname: N'Gom
authors.forename: T
authors.initials: T
authors.lastname: Corrah
authors.forename: R
authors.initials: R
authors.lastname: Tedder
authors.forename: H
authors.initials: H
authors.lastname: Whittle
mesh_terms: D000293:Adolescent; D000328:Adult; D000354:Africa, Western; D000368:Aged; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000097:blood; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000821:virology; D015498:HIV-2 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008137:Longitudinal Studies; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011533:Proviruses / Q000235:genetics / Q000302:isolation & purification; D012367:RNA, Viral / Q000097:blood*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral