title: Relationship between HIV coreceptor tropism and disease progression in persons with untreated chronic HIV infection.
abstract: OBJECTIVE
  To assess the effect of HIV coreceptor tropism (CRT) on the relative risk of progression to a composite outcome of CD4 count < or =350 cells per microliter, treatment initiation, or death.
  
  
  METHODS
  CRT assays were performed after study closure in baseline samples obtained from enrollees in a prospectively monitored cohort of treatment-naive adults with > or =450 CD4 cells per microliter and > or =1000 HIV-1 RNA copies per milliliter.
  
  
  RESULTS
  Dual/mixed (D/M) and R5 CRT were detected in 32 and 282 patients, respectively. The baseline CD4 count (617 versus 694 cells/microL; P = 0.05) differed in patients with D/M versus R5 CRT. Otherwise, baseline laboratory characteristics were similar.The relative risk of progression to the composite end point was 2.15 (P = 0.002) for D/M versus R5 CRT, 2.07 per 1.0 log10 higher viral load (P < 0.001) and 0.87 per 50 cells per microliter higher CD4 cell count (P < 0.001). The effect of D/M CRT was also significant in separate analyses of time to initiation of antiretroviral therapy or CD4 cell count < or =350 cells per microliter.
  
  
  CONCLUSIONS
  Untreated patients with D/M rather than R5 CRT had a faster rate of disease progression, whether assessed by a composite outcome of time to CD4 count < or =350 cells per microliter, treatment initiation, or death or by separate analyses of time to CD4 count < or =350 cells per microliter or treatment initiation.
authors.affiliation: Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. matthew.goetz@va.gov
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Robert
authors.initials: R
authors.lastname: Leduc
authors.forename: Jay R
authors.initials: JR
authors.lastname: Kostman
authors.forename: Ann M
authors.initials: AM
authors.lastname: Labriola
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Lie
authors.forename: Jodi
authors.initials: J
authors.lastname: Weidler
authors.forename: Eoin
authors.initials: E
authors.lastname: Coakley
authors.forename: Michael
authors.initials: M
authors.lastname: Bates
authors.forename: Roberta
authors.initials: R
authors.lastname: Luskin-Hawk
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000503:physiopathology / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000235:genetics; D015728:Receptors, HIV / Q000502:physiology*; D019562:Viral Load
chemical_list: D012367:RNA, Viral; D015728:Receptors, HIV