HIV-1 RNA, CD4 T-lymphocytes, and clinical response to highly active antiretroviral therapy.

Abstract

OBJECTIVE:

To determine if HIV-1 RNA and CD4 lymphocyte thresholds for the initiation of highly active antiretroviral therapy (HAART) are associated with clinical response to therapy.

DESIGN:

Observational cohort study.

SETTING:

Johns Hopkins Hospital HIV Clinic.

PATIENTS:

HIV-infected adults.

INTERVENTION:

Patients initiating HAART (n = 530) were compared with concurrent patients who did not receive HAART (n = 484).

MAIN OUTCOME MEASURE:

Progression to a new AIDS-defining illness or death.

RESULTS:

The average duration of follow-up for the cohort was 22 months. HAART resulted in decreased disease progression among persons with fewer than, but not more than, 200 x 10(6) CD4 lymphocytes/l prior to treatment. Among persons receiving HAART, plasma HIV-1 RNA level prior to therapy was not associated with HIV disease progression within CD4 T-lymphocyte count strata. In a Cox multivariate proportional hazards model that adjusted for age, sex, race, prior opportunistic infection, and CD4 T lymphocytes, < or = 200 x 10(6) CD4 lymphocytes/l was the strongest predictor of disease progression. HIV-1 RNA level prior to starting HAART of < 5000 copies/ml, 5001-55 000 copies/ml, or > 55 000 copies/ml was not associated with disease progression on therapy, particularly among persons with > 200 x 10(6) CD4 lymphocytes/l. There was no sex difference in disease progression on treatment.

CONCLUSIONS:

Our data suggest that current guidelines for initiating HAART should place greater emphasis on CD4 lymphocyte than HIV-1 RNA level for both men and women. Further longitudinal follow-up will be needed to better ascertain whether HAART initiated at > 200 x 10(6) CD4 lymphocytes/l is effective in slowing disease progression.

• Authors: T R Sterling, R E Chaisson, R D Moore
• Journal: AIDS (London, England) (AIDS) Vol. 15 Issue 17 Pg. 2251-7 (Nov 23 2001) ISSN: 0269-9370 [Print] England
• PMID: 11698698 (Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)

Chemical References

• RNA, Viral

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antiretroviral Therapy, Highly Active (standards)
• CD4 Lymphocyte Count
• CD4-Positive T-Lymphocytes (cytology)
• Cohort Studies
• Disease Progression
• Female
• HIV Infections (drug therapy, immunology, physiopathology, virology)
• HIV-1 (genetics)
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• RNA, Viral (blood)
• Sex Factors
• Treatment Outcome
• Viral Load