Early markers of HIV-1 disease progression in a prospective cohort of seroconverters in Bangkok, Thailand: implications for vaccine trials.
BACKGROUND
Some candidate HIV-1 vaccines may not prevent HIV-1 infection but may alter the course of disease. Surrogate endpoints based on early laboratory makers in HIV-1-infected persons who are antiretroviral therapy (ART)-naive will be useful for evaluating vaccine efficacy in slowing disease progression (VEp). We examined pretreatment HIV-1 viral loads and CD4 cell counts in recent HIV-1 seroconverters to inform selection of these endpoints.


METHODS
We studied 130 newly HIV-1-infected injection drug users identified from a prospective cohort of initially uninfected persons in Bangkok during 1995 through 1998. We analyzed trends in HIV-1 viral loads and CD4 cell counts as well as progression to the surrogate endpoint, defined as 2 consecutive CD4 cell counts of fewer than 350 cells/mm, during 24 months after the first HIV-1 seropositive (FP) visit.


RESULTS
Median HIV-1 RNA copies/mL with interquartile ranges were 43,693 (14,320-94,767) at the FP visit, 46,924 (16,273-104,314) at 6 months, 28,446 (11,292-54,325) at 12 months, and 18,080 (8713-54,059) at 18 months. HIV-1 viral loads at the FP visit and at 18 months were positively correlated (r = 0.53, P < 0.0001). Of 130 participants, 12% reached the surrogate endpoint by 6 months, 16% by 12 months, and 27% by 18 months. In Cox regression analyses, HIV-1 viral loads of more than 50,000 copies/mL at the FP visit (hazard ratio [HR] = 2.3, 95% confidence interval [CI]: 1.1-4.8) and first CD4 cell count of 500 or fewer cells/mm (HR = 7.6, 95% CI: 3.2-17.6) were independently associated with faster progression to the surrogate endpoint.


CONCLUSIONS
Participants with high HIV-1 RNA levels and low CD4 cell counts close to the time of seroconversion were more likely to experience early immunologic progression. Approximately one quarter of seroconverters reached the surrogate immunologic endpoint within 18 months of their FP visit and before starting ART, suggesting the utility of this endpoint for analyses of VEp in some ongoing and planned HIV-1 vaccine efficacy trials.
Buchacz
Kate
K
Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. acu7@cdc.gov
Hu
Dale J
DJ
Vanichseni
Suphak
S
Mock
Philip A
PA
Chaowanachan
Thanyanan
T
Srisuwanvilai
La-ong
LO
Gvetadze
Roman
R
Van Griensven
Frits
F
Tappero
Jordan W
JW
Kitayaporn
Dwip
D
Kaewkungwal
Jaranit
J
Choopanya
Kachit
K
Mastro
Timothy D
TD
D016915:AIDS Vaccines; D000328:Adult; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D002986:Clinical Trials as Topic / Q000379:methods; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000209:etiology* / Q000276:immunology / Q000821:virology; D006679:HIV Seropositivity / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D013785:Thailand; D013997:Time Factors
D016915:AIDS Vaccines; D015415:Biomarkers; D012367:RNA, Viral