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

AIDS. 2001 Nov 23;15(17):2251-7. doi: 10.1097/00002030-200111230-00006.

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.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • 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
  • HIV Infections / immunology
  • HIV Infections / physiopathology*
  • HIV Infections / virology
  • HIV-1 / genetics*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • RNA, Viral / blood*
  • Sex Factors
  • Treatment Outcome
  • Viral Load

Substances

  • RNA, Viral