Prognostic value of plasma HIV RNA and CD4+ count for clinical endpoints in CPCRA 036 melanie

A. Thompson, G. Perez, J. Neaton, S. Howard, J. Baxter, M. Dehlinger, D. Mayers, Rodger David MacArthur, D. Chernoff

Research output: Contribution to journalArticle

Abstract

Objective: To compare the prognostic value of HIV RNA and CD4+ cell count for disease progression and survival. Methods: Patients with CD4+ < 300 cells/μl were enrolled in a strategy trial of decision making with or without plasma HIV RNA quantitation. Two HIV RNA (hDNA) and CD4+ assays were obtained at baseline for all patients and at least every four months in 66% of patients. Proportional hazards regression was used to assess the relationship of HIV RNA and CD4+ to clinical disease progression and death over a median follow-up of 12 months. Results: 1485 patients were enrolled of whom 219 had clinical events. At baseline, median HIV RNA and CD4+ counts were 40.4 Keq/ml and 155 cells/μl. A 0.5 log lower viral load at baseline was associated with a 30% lower rate of disease progression (p<0.0001) after adjustment for baseline CD4+. Relative risk (RR) estimates for each of the upper tertiles of baseline HIV RNA compared to the lower tertile were 1.5 (p=0.13) and 3.3 (p=0.0001) after adjustment for log CD4+. For baseline CD4+ cell count, RRs for each of the lower two tertiles compared to the highest were 3.3 (p=0.0004) and 10.9 (p=0.0001) after adjustment for log HIV RNA. A 0.5 log decrease in HIV RNA at 4 months was associated with a 35% lower risk of disease progression (p<0.0001), adjusted for CD4+ change. Conclusions: Baseline CD4+ was a stronger predictor of disease progression or death than baseline HIV RNA in this population. Both baseline and change in HIV RNA after 4 months were strong predictors of progression.

Original languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
StatePublished - 1997

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Thompson, A., Perez, G., Neaton, J., Howard, S., Baxter, J., Dehlinger, M., Mayers, D., MacArthur, R. D., & Chernoff, D. (1997). Prognostic value of plasma HIV RNA and CD4+ count for clinical endpoints in CPCRA 036 melanie. Clinical Infectious Diseases, 25(2).