Plasma viral load, CD4 cell percentage, HLA and survival of HIV-1, HIV-2, and dually infected Gambian patients.
OBJECTIVE
To examine baseline plasma viral loads according to the CD4 cell percentage (CD4%) in HIV-1, HIV-2 and dually infected patients (HIV-D), and to relate these measurements to survival.


METHODS
A total of 119 HIV-1, 137 HIV-2 and 81 HIV-D-infected patients attending the Medical Research Council clinic in The Gambia were recruited from 1991 according to baseline CD4%, and followed until death or the end of December 2000. HIV-1 and HIV-2 RNA levels were measured by in-house reverse transcriptase polymerase chain reaction assays.


RESULTS
The plasma viral load, which varied inversely with CD4%, was similar in HIV-1 singly and dually infected patients, but was significantly higher in HIV-1 than in HIV-2 singly infected patients, except in those with a CD4% less than 14%. HIV-2 plasma viral load in dually infected patients did not vary significantly with CD4%, but was significantly lower than in HIV-2 singly infected patients with CD4% less than 14%. Multivariate analysis showed that only CD4% was independently associated with survival in HIV-1 and HIV-D infections; whereas both CD4% and plasma viral load were independently associated with survival in HIV-2 infections. The mortality rate of HIV-D-infected patients was not significantly different from that of HIV-1-infected patients, but was significantly higher in the absence of HLA B58.


CONCLUSIONS
HIV-2 infection does not alter HIV-1 replication or prolong survival in dually infected patients. In a clinical setting in Africa, where many patients present with advanced disease, CD4% may be a more important predictor of prognosis than plasma viral load.
Alabi
Abraham S
AS
Medical Research Council Laboratories, Banjul, The Gambia, West Africa.
Jaffar
Shabbar
S
Ariyoshi
Koya
K
Blanchard
Tom
T
Schim van der Loeff
Maarten
M
Awasana
Akum Aveika
AA
Corrah
Tumani
T
Sabally
Sehu
S
Sarge-Njie
Ramu
R
Cham-Jallow
Fatim
F
Jaye
Assan
A
Berry
Neil
N
Whittle
Hilton
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D005714:Gambia; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality / Q000821:virology*; D015497:HIV-1 / Q000235:genetics; D015498:HIV-2 / Q000235:genetics; D015235:HLA-B Antigens / Q000032:analysis*; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D013223:Statistics as Topic; D015996:Survival Rate; D019562:Viral Load
D015235:HLA-B Antigens; D012367:RNA, Viral