Plasma RNA viral load predicts the rate of CD4 T cell decline and death in HIV-2-infected patients in West Africa.
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.
Ariyoshi
K
K
Medical Research Council Laboratories, The Gambia, West Africa.
Jaffar
S
S
Alabi
A S
AS
Berry
N
N
Schim van der Loeff
M
M
Sabally
S
S
N'Gom
P T
PT
Corrah
T
T
Tedder
R
R
Whittle
H
H
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
D004279:DNA, Viral; D012367:RNA, Viral