title: Prognostic value of changes in CD4 count and HIV RNA during the first six months on highly active antiretroviral therapy in chronic human immunodeficiency virus infection.
abstract: The aim of this study was to evaluate the prognostic value of changes in CD4 counts and human immunodeficiency virus (HIV) RNA following 6 months of highly active antiretroviral therapy (HAART) in chronic HIV-1 infection. 148 treatment-naive patients treated with 2 nucleoside analogue reverse transcriptase inhibitors (NRTIs) + at least 1 protease inhibitor or non-NRTI for at least 180 d were included. Mean follow-up time after 6 months on HAART was 758 d. The patients were divided into 2 groups based on the increase in CD4 count (deltaCD4) from therapy initiation: groups A (n = 37, deltaCD4 < 0.052 x 10(9)/l) and B (n = 111, deltaCD4 > or = 0.052 x 10(9)/l). Patients were also stratified according to achievement of HIV RNA < 400 copies/ml (n = 122) or > or = 400 copies/ml (n = 26). Endpoints were the occurrence of subsequent HIV-related disease (CDC category B or C) or death after 6 months on HAART. Subjects in group A had an increased risk of HIV-related disease compared with group B when adjusted for CD4 count at initiation of therapy [adjusted risk ratio (RR) 2.62, 95% confidence interval (95% CI) 1.07-6.40]. Viral load > or = copies/ml versus reaching viral suppression < 400 copies/ml was associated with an increased risk of HIV-related disease only in patients with deltaCD4 < 0.052 x 10(9)/l (RR 4.20, 95% CI 1.05-16.9). Thus, this study indicates that patients with no or a small increase in CD4 counts after 6 months of HAART and low CD4 levels at initiation of therapy have an increased risk of HIV-related disease.
authors.affiliation: Department of Infectious Diseases, Ullevål University Hospital, Oslo, Norway. vidar.ormaasen@ioks.uio.no
authors.forename: Vidar
authors.initials: V
authors.lastname: Ormaasen
authors.forename: Johan N
authors.initials: JN
authors.lastname: Bruun
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.forename: Mona
authors.initials: M
authors.lastname: Holberg-Petersen
authors.forename: Per Ivar
authors.initials: PI
authors.lastname: Gaarder
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D006678:HIV / Q000235:genetics / Q000276:immunology / Q000502:physiology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D006801:Humans; D008297:Male; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D016019:Survival Analysis; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral