BACKGROUND: The study objective was to compare the prognostic value of plasma HIV RNA and CD4 cell count at baseline and as time-updated variables in highly active antiretroviral therapy (HAART) users for two outcomes: development of AIDS and change in CD4 cell count. METHODS: The study population comprised 387 men enrolled in the Multicenter AIDS Cohort Study who were AIDS-free and initiated HAART between 1996 and 2001. Follow-up until AIDS diagnosis (n=36, 9%) or the last AIDS-free visit was included. To determine the predictive value of combining HIV RNA and CD4 cell count, regression tree methods using recursive partitioning at pre-specified cut points for both variables were used. RESULTS: Low CD4 cell count was a strong predictor of AIDS among HAART users. However, HIV RNA showed strong prognostic value for AIDS development among those with CD4 cell counts > 250 x 10(6) cells/l, in whom an HIV RNA level > 1000 copies/ml carried a 4.6-fold greater risk of developing AIDS. HIV RNA < 5000 copies/ml was also predictive of subsequent increase in CD4 cell count with significantly higher increases among those with initial CD4 counts > 300 x 10(6) cells/l. CONCLUSION: Although, in HAART users, CD4 cell count was the primordial prognostic marker, an HIV RNA > 1000 copies/ml attained after HAART initiation was a strong predictor of the rate of subsequent CD4 cell count increase and of developing AIDS in patients whose CD4 cell counts were > 250 x 10(6) cells/l.
BACKGROUND: The study objective was to compare the prognostic value of plasma HIV RNA and CD4 cell count at baseline and as time-updated variables in highly active antiretroviral therapy (HAART) users for two outcomes: development of AIDS and change in CD4 cell count. METHODS: The study population comprised 387 men enrolled in the Multicenter AIDS Cohort Study who were AIDS-free and initiated HAART between 1996 and 2001. Follow-up until AIDS diagnosis (n=36, 9%) or the last AIDS-free visit was included. To determine the predictive value of combining HIV RNA and CD4 cell count, regression tree methods using recursive partitioning at pre-specified cut points for both variables were used. RESULTS: Low CD4 cell count was a strong predictor of AIDS among HAART users. However, HIV RNA showed strong prognostic value for AIDS development among those with CD4 cell counts > 250 x 10(6) cells/l, in whom an HIV RNA level > 1000 copies/ml carried a 4.6-fold greater risk of developing AIDS. HIV RNA < 5000 copies/ml was also predictive of subsequent increase in CD4 cell count with significantly higher increases among those with initial CD4 counts > 300 x 10(6) cells/l. CONCLUSION: Although, in HAART users, CD4 cell count was the primordial prognostic marker, an HIV RNA > 1000 copies/ml attained after HAART initiation was a strong predictor of the rate of subsequent CD4 cell count increase and of developing AIDS in patients whose CD4 cell counts were > 250 x 10(6) cells/l.
Authors: Chun Chao; Beth Tang; William Towner; Michael J Silverberg; Leo Hurley; Michael Horberg Journal: AIDS Patient Care STDS Date: 2012-03-16 Impact factor: 5.078
Authors: Xiuhong Li; Joseph B Margolick; Beth D Jamieson; Charles R Rinaldo; John P Phair; Lisa P Jacobson Journal: J Acquir Immune Defic Syndr Date: 2011-08-15 Impact factor: 3.731
Authors: Xiuhong Li; Haitao Chu; Joel E Gallant; Donald R Hoover; Wendy J Mack; Joan S Chmiel; Alvaro Muñoz Journal: J Epidemiol Community Health Date: 2006-09 Impact factor: 3.710
Authors: Hemant Kulkarni; Jason F Okulicz; Greg Grandits; Nancy F Crum-Cianflone; Michael L Landrum; Braden Hale; Glenn Wortmann; Edmund Tramont; Michael Polis; Matthew Dolan; Alan R Lifson; Brian K Agan; Sunil K Ahuja; Vincent C Marconi Journal: J Acquir Immune Defic Syndr Date: 2011-08-15 Impact factor: 3.731
Authors: Vincent C Marconi; Greg A Grandits; Amy C Weintrob; Helen Chun; Michael L Landrum; Anuradha Ganesan; Jason F Okulicz; Nancy Crum-Cianflone; Robert J O'Connell; Alan Lifson; Glenn W Wortmann; Brian K Agan Journal: AIDS Res Ther Date: 2010-05-27 Impact factor: 2.250