Clinical prognosis of patients with early-stage human immunodeficiency virus (HIV) disease: contribution of HIV-1 RNA and T lymphocyte subset quantitation.
Systems for the staging of individuals with human immunodeficiency virus type 1 (HIV-1) infection were developed 15 years ago. Subsequently, assays for quantitating HIV-1 RNA and immunophenotyping of lymphocyte subsets have been developed and validated. The utility of these assays for improved staging in early disease was evaluated in 256 HIV-infected adults (52% minority) with CD4 counts > or = 400 cells/microL followed in U.S. military medical centers before the highly active anti-retroviral therapy era. HIV viral load (RNA) was quantitated; the frequencies of select CD4+ immunophenotypes were determined in 112 subjects. The results were analyzed in relation to three outcome measures: death, first acquired immunodeficiency syndrome-defining opportunistic infection, and CD4 count < or = 200 cells/microL. Serum RNA level and CD4 count were each found to be predictive of all three outcomes. In addition, increases in the T-cell subsets CD28-CD4+ and CD29+CD26-CD4+ were found to be independently predictive of more rapid progression. The classification of early-stage HIV patients is improved by the quantitation of both viral RNA and T-lymphocyte subsets.
Brown
A E
AE
Walter Reed Army Institute of Research, Washington, DC, USA. brownae@thai.amedd.army.mil
Dolan
M J
MJ
Michael
N L
NL
Zhou
S
S
Perfetto
S P
SP
Hawkes
C
C
Robb
M
M
Lane
J
J
Mayers
D
D
McNeil
J G
JG
Malone
J D
JD
Garner
R
R
Birx
D L
DL
D000328:Adult; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D015497:HIV-1; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood*; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016176:T-Lymphocyte Subsets
D012367:RNA, Viral