[Survival and disease progression in 251 patients with HIV-1 infection. Study of p24 antigen and viral burden as prognosis makers. Their value at 4 years of follow-up].
BACKGROUND
Prospective study of survival and AIDS or death progression in a cohort of 251 HIV infected patients whose seroconversion time is unknown, with a main objective: To analyse p24 antigen plasmatic levels and viral load as surrogate markers.


METHODS
251 patients were included, most of them undergoing antiretroviral therapy, and were followed-up consecutively in the HIV/AIDS Unity of Internal Medicine Service of the Hospital Universitario Arnau de Vilanova in Lleida.


METHODS
We made clinical and analytical baseline studies and every 3 months thereafter. Related to p24 antigen 3 group were established: group I, < 20 pg/mL, group 2, 20-39 pg/mL, group 3, 40 or more pg/mL. We studied survival and progression according to baseline levels over 4 year period. Regard to viral load, we just compared this with p24 antigen in the last phase of the study (third and fourth year) for technical reasons. Survival analysis was made by Kaplan-Meier estimation. Relative risk was calculated by Cox's proportional hazards model.


RESULTS
During the 48 months of follow-up 55 patients died. AIDS progression risk or death was 4.8 times higher for the p24 antigen > = 40 pg/mL group than for the p24 antigen < 20 pg/mL one; the relative risk of patients with p24 antigen between 20-39 pg/mL was 2.5 times higher than those included in the group of p24 antigen < 20 pg/mL. Related to progression study, 34 patients progressed. AIDS progression risk or death for p24 antigen > = 40 pg/mL group was 7.69 times higher compared with group 2 (p24 antigen levels between 20-39 pg/mL). The comparison with viral load by PCR determination shows controversial results.


CONCLUSIONS
p24 antigen plasma level is a good survival and AIDS progress or death surrogate markers in HIV infected patients, and it is useful for 4 years or more. An isolated value < 20 pg/mL is a sign of good prognosis. Parallelism between p24 antigen plasmatic level and viral load has not been observed.
Rubio Caballero
M
M
Servicios de Medicina Interna y Análisis Clínicos (Sección de Microbiología), Hospital Universitario Arnau de Vilanova, Lleida.
Rubio Rivas
C
C
Nogués Biau
A
A
Falguera Sacrest
M
M
Manonelles Fernández
A
A
D000328:Adult; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005500:Follow-Up Studies; D016655:HIV Core Protein p24 / Q000097:blood*; D015658:HIV Infections / Q000097:blood* / Q000401:mortality* / Q000821:virology; D006801:Humans; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D019562:Viral Load
D015415:Biomarkers; D016655:HIV Core Protein p24
Supervivencia y progresión de la enfermedad en 251 pacientes con infección por el VIH-1. Estudio del antígeno p24 y de la carga viral como marcadores pronóstico. Su valor a los 4 años de seguimiento.