Predictive value of HIV-1 viral load on risk for opportunistic infection.
OBJECTIVE
The relationship between HIV-1 viral load and the risk for opportunistic infection (OI) was examined in Adult AIDS Clinical Trial Group (AACTG) 722, a virology substudy of AACTG 323: a phase 4 randomized study designed to examine the use of chronic suppressive versus episodic fluconazole therapy.


METHODS
The primary analysis used a case-control sampling scheme with two controls per "case" (subjects that developed an OI) matched by gender, age, and time on study. Forty-five cases and matched controls were identified and used in the analysis.


RESULTS
Study 722 accrued 518 subjects between 5/97 and 11/99. Forty-five subjects developed serious OIs or refractory candidiasis. Median baseline CD4 count was 24 cell/mm3 for cases and 46 for controls (p =.003). Median viral load (VL) was 5.02 log10 copies/mL for cases and 4.08 for controls (p =.002). Multivariate analysis found four independent variables associated with time to OI: baseline VL and CD4 (RR = 2.2 per log increment and 6.0 per 50-cell increment, respectively), a one log increase in VL at any time (RR = 15), and history of an OI (RR = 5.2).


CONCLUSIONS
VL and changes in VL were independently associated with risk of development of OIs in a prospective study and should be considered by clinicians when assessing patients for risk of OI.
Swindells
Susan
S
University of Nebraska Medical Center, Omaha 68198-5400, USA. sswindells@unmc.edu
Evans
Scott
S
Zackin
Robert
R
Goldman
Mitchell
M
Haubrich
Richard
R
Filler
Scott G
SG
Balfour
Henry H
HH
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002180:Candidiasis, Oral / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000097:blood*; D012307:Risk Factors; D019562:Viral Load
D000935:Antifungal Agents; D012367:RNA, Viral; D015725:Fluconazole