p24 as a predictor of mortality in a cohort of HIV-1-infected adults in rural Africa.
BACKGROUND
Implementation of antiretroviral treatment in sub-Saharan Africa requires efficient tools to monitor HIV patients. p24 measurements have been proposed as an alternative to HIV-RNA because of the low cost of reagents and equipment needed. Here, we evaluate p24 as a prognostic marker in a cohort of HIV-1-infected individuals in Zimbabwe.


METHODS
Treatment-naive HIV-1-infected individuals (n=198) from the Mupfure Schistosomiasis and HIV Cohort were followed until death or censoring (3-4.3 years). At baseline, p24, HIV-RNA, CD4 cell counts, and clinical staging (Centers for Disease Control and Prevention classification) were assessed.


RESULTS
p24 correlated with HIV-RNA (P<0.0001, R: 0.44). Ten percent of p24 but only 1% of HIV-RNA measurements was undetectable. p24 predicted Centers for Disease Control and Prevention category (P<0.001) stronger than CD4 count (P=0.34) in multivariate logistic regression. p24 predicted mortality in univariate Cox analysis (P<0.0001) and in multivariate analysis, but it was inferior to HIV-RNA and CD4 count.


CONCLUSIONS
This is the first study to evaluate the prognostic strength of p24 in an area with a predominance of HIV subtype C infections. p24 correlated with HIV-RNA and predicted clinical stage better than CD4 count. It predicted mortality in both univariate and multivariate analysis, but in multivariate analysis, it was inferior to HIV-RNA and CD4 count.
The Centre of Inflammation and Metabolism, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. erikstrup@dadlnet.dk
Christian
C
Erikstrup
Per
P
Kallestrup
Rutendo B L
RB
Zinyama-Gutsire
Exnevia
E
Gomo
Margrethe
M
Lüneborg-Nielsen
Jan
J
Gerstoft
Jörg
J
Schüpbach
Henrik
H
Ullum
Terese L
TL
Katzenstein
D000163:Acquired Immunodeficiency Syndrome; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D018791:CD4 Lymphocyte Count; D016655:HIV Core Protein p24 / Q000032:analysis*; D015658:HIV Infections / Q000401:mortality*; D015497:HIV-1 / Q000235:genetics / Q000378:metabolism*; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D012367:RNA, Viral; D016019:Survival Analysis; D015030:Zimbabwe
D015415:Biomarkers; D016655:HIV Core Protein p24; D012367:RNA, Viral