Viral load and risk of specific opportunistic infections in patients with CD4 Counts <300 cells/mm3 enrolled in CPCRA 036

J. D. Baxter, M. A. Thompson, Rodger David MacArthur, N. P. Markowitz, D. L. Mayerc, M. A. LiVolsi, L. H. Makohon, M. E. Dehlincer, S. F. Howard, J. D. Neaton

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Abstract

Objective: To determine if HIV RNA measurements provide additional information to the CD4 count in predicting the development of PCP, esophageal candidiasis (EC), CMV and disseminated MAC in HIV infected individuals with CD4 counts <300 cells/mm3. Methods: Using data from CPCRA 036, a strategy trial comparing antiretroviral management with or without HIV RNA quantitation (Chiron bDNA assay) in patients with CD4 counts <300 cells/mm3, the prognostic importance of baseline levels of log10 HIV RNA and log10 CD4 cell count (average of 2 readings) for PCP, EC, CMV, and MAC was assessed using proportional hazards regression over a median of 12 months. Results: 1,485 patients were randomized with a median HIV RNA and CD4 count of 40,400 copies/ml and 155 cells/mm3. The number of opportunistic infections (OI) events were: PCP 62, EC 49, CMV 38, and MAC 24. In univariate analyses, both CD4 cell count and HIV RNA were significantly related to each OI; risk gradients were stronger for MAC>CMV>PCP>EC. After adjusting for CD4 count, a 1 log higher HIV RNA resulted in a 2.8 fold increased risk of PCP (p<0.00l); a 1.5 fold increased risk for EC (p=0.15); a 2.8 fold increased risk for CMV(p<0.001) and; a 5.7 fold increased risk for MAC (p<0.001). For patients with baseline CD4 counts <50, the risk of PCP was 4.4 times higher for patients with baseline RNAs ≥50,000 compared to those with RNAs <50,000 (p=0.01). For patients with baseline CD4 counts ≥50, the risk was 3.2 times higher for patients with RNAs ≥50,000 versus those <50,000 (p=0.01). Conclusion: In patients with advanced HIV disease, the risk for developing PCP, CMV and MAC is influenced by the HIV RNA level as well as by the CD4 count.

Original languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Volume25
Issue number2
Publication statusPublished - Dec 1 1997
Externally publishedYes

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ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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Baxter, J. D., Thompson, M. A., MacArthur, R. D., Markowitz, N. P., Mayerc, D. L., LiVolsi, M. A., ... Neaton, J. D. (1997). Viral load and risk of specific opportunistic infections in patients with CD4 Counts <300 cells/mm3 enrolled in CPCRA 036. Clinical Infectious Diseases, 25(2).