title: Time-updated CD4+ T lymphocyte count and HIV RNA as major markers of disease progression in naive HIV-1-infected patients treated with a highly active antiretroviral therapy: the Aquitaine cohort, 1996-2001.
abstract: In naive HIV-1 infected patients who start a highly active antiretroviral therapy (HAART), the relationship between time-updated CD4+ cell count, HIV RNA, and clinical progression (new AIDS-defining event or death) is incompletely understood. A 2-step statistical approach was adopted: first, modeling the evolution of the 2 markers taking into account left-censoring of HIV RNA and, second, studying their respective effect on clinical progression. The study sample consisted in 551 previously untreated patients of the Aquitaine Cohort who started their first HAART regimen between 1996 and 2000. During a median follow-up of 33 months, 46 patients experienced a new AIDS-defining diagnosis and 23 died. In multivariate survival analysis, time-updated CD4+ cell count (hazard ratio [HR] = 1.92 for 100 cells/mm3 lower, P < 10(-4) and HIV RNA (HR = 1.30 for 1 log(10) copies/mL higher, P = 0.04) on continuous scale were associated with clinical progression. When analyzing the effect of updated biomarkers using usual thresholds, the association with clinical progression was weaker for CD4+ but still significant (P = 0.007) whereas it remained only significant for updated HIV RNA above 4 log(10) copies/mL (P = 0.01). The prognostic information of updated HIV RNA adjusted on updated CD4+ is significant but depends on how the markers are taken into account. Clinical decisions and interpretation of clinical trial results must weigh the signification of each of these 2 biomarkers.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale Unité 330, Institut de Santé Publique, d'Epidémiologie et de Développement, Université Victor Segalen, Bordeaux, France.
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thiébaut
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.forename: Hélène
authors.initials: H
authors.lastname: Jacqmin-Gadda
authors.forename: Philippe
authors.initials: P
authors.lastname: Morlat
authors.forename: Patrick
authors.initials: P
authors.lastname: Mercié
authors.forename: Michel
authors.initials: M
authors.lastname: Dupon
authors.forename: Didier
authors.initials: D
authors.lastname: Neau
authors.forename: Hanta
authors.initials: H
authors.lastname: Ramaroson
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Roger
authors.initials: R
authors.lastname: Salamon
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology* / Q000276:immunology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000097:blood*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D012367:RNA, Viral