PROGNOSTIC VALUE OF VIREMIA IN PATIENTS WITH LONG-STANDING HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Human immunodeficiency virus (HIV) viremia was evaluated in 73 patient s with long-standing infection to investigate its relationship with cl inical or biologic parameters and to assess its use as a predictor of clinical progression and death. After adjustment for other parameters, baseline HIV RNA level was significantly associated with baseline cli nical stage and CD4 cell count. During follow-up (mean, 14.6 months), 16 patients died; 34 others had clinical progression of disease, In mu ltivariate analysis, mortality was better predicted by baseline CD4 ce ll count (relative hazard [RH] for 100-cell decrease, 3.5; 95% confide nce interval [CI], 1.5-8.2; P =.003) than by HIV RNA (P =.28) or clini cal stage. HIV RNA level was the best predictor of clinical progressio n (RH for 1 log increase, 2.8; 95% CI, 1.6-4.9; P <.001). Monitoring o f HIV RNA level may help to identify patients who might benefit from a ntiretroviral or prophylactic therapy.