title: CD4 cell count and HIV DNA level are independent predictors of disease progression after primary HIV type 1 infection in untreated patients.
abstract: BACKGROUND
  Treatment initiation at the time of primary human immunodeficiency virus (HIV) type 1 (HIV-1) infection has become less frequent in recent years.
  
  
  METHODS
  In the French prospective PRIMO Cohort, in which patients are enrolled at the time of primary HIV-1 infection, 30% of the 552 patients recruited during 1996-2004 did not start receiving antiretroviral treatment during the first 3 months after diagnosis. We analyzed the patients' clinical and immunological outcomes and examined potential predictors of disease progression. Progression was defined as the occurrence of an acquired immunodeficiency syndrome (AIDS)-related clinical event or a CD4 cell count <350 cells/mm3.
  
  
  RESULTS
  Fifty-six (34%) of the untreated patients experienced immunological progression during a median duration of follow-up of 24 months, and 1 of these patients had an AIDS-related event. The estimated risks of progression were 25%, 34%, and 42% at 1, 2, and 3 years after enrollment, respectively. Compared with patients who did not have progression, those with progression had significantly lower CD4 cell counts at diagnosis (455 vs. 738 cells/mm3), higher plasma HIV RNA levels (4.9 vs. 4.5 log10 copies/mL), and higher HIV DNA levels (3.3 vs. 3.0 log(10) copies/10(6) peripheral blood mononuclear cells [PBMCs]). All 3 parameters were significantly associated with progression in univariate analysis. In multivariate analysis, only the CD4 cell count and HIV DNA level were independently predictive of disease progression (relative hazard for CD4 cell count, 1.84 per decrease of 100 cells/mm3; relative hazard for HIV DNA level, 2.73 per increase of 1 log(10) copies/10(6) PBMCs).
  
  
  CONCLUSIONS
  Both a low initial CD4 cell count and a high HIV DNA level are predictive of rapid progression of untreated primary HIV-1 infection. Affected patients may therefore benefit from close clinical and laboratory monitoring and/or early administration of treatment.
authors.affiliation: Service de Médecine Interne, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. cecile.goujard@bct.aphp.fr
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
authors.forename: Mojgan
authors.initials: M
authors.lastname: Bonarek
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bonnet
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Chaix
authors.forename: Christiane
authors.initials: C
authors.lastname: Deveau
authors.forename: Martine
authors.initials: M
authors.lastname: Sinet
authors.forename: Julie
authors.initials: J
authors.lastname: Galimand
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Delfraissy
authors.forename: Alain
authors.initials: A
authors.lastname: Venet
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.forename: Philippe
authors.initials: P
authors.lastname: Morlat
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000097:blood*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000276:immunology* / Q000821:virology*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male
chemical_list: D019380:Anti-HIV Agents; D015415:Biomarkers; D004279:DNA, Viral