CD4 cell count and HIV DNA level are independent predictors of disease progression after primary HIV type 1 infection in untreated patients.
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.
Goujard
Cécile
C
Service de Médecine Interne, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. cecile.goujard@bct.aphp.fr
Bonarek
Mojgan
M
Meyer
Laurence
L
Bonnet
Fabrice
F
Chaix
Marie-Laure
ML
Deveau
Christiane
C
Sinet
Martine
M
Galimand
Julie
J
Delfraissy
Jean-François
JF
Venet
Alain
A
Rouzioux
Christine
C
Morlat
Philippe
P
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
D019380:Anti-HIV Agents; D015415:Biomarkers; D004279:DNA, Viral