PROGNOSTIC VALUE OF VARIOUS PATTERNS OF C HANGE IN CD4-LYMPHOCYTE COUNT IN 420 ASYMPTOMATIC HIV-1-INFECTED PATIENTS

The pattern of change over time of CD4-lymphocyte counts was investiga ted prospectively in 420 patients infected with HIV-1 (106 women, 314 men; mean age 34.9 [21-70] years) to assess its value in prognosticati ng progression to AIDS. Only those CD4-lymphocyte values were taken in to account which had been measured in the asymptomatic stage of the HI V infection and before introduction of antiviral treatment. An average of 4.5 (range 3-10) measurements per person were available. Mean obse rvation time was 2.4 years, the mean annual CD4-lymphocyte decrease wa s 48 cells/mul. 121 patients (28.8%) had a fall in CD4-lymphocyte coun t which in the regression analysis significantly differed from zero. I n this group there occurred 19 progressions to AIDS (15.7%), in contra st to only 20 (6.6%) in the 299 patients with a nonsignificant CD4 fal l (P < 0.01). Multivariate analysis with the Cox regression indicated that the annual reduction in the CD4 count and the initial CD4 count w ere the only values of prognostic significance regarding progression t o AIDS. There was no evidence that percentage and absolute CD4-lymphoc yte counts had a different predictive value. When the inital CD4 count was high (> 900 cells/mul), there was on average a steeper reduction in CD4-lymphocyte counts than when it was lower. This findings argues against a linear CD4 fall during the total period of observation. The annual CD4 fall, described with linear regression, is a prognostic cri terion on its own for early recognition of those patients at a high ri sk of progression to AIDS while still in the asymptomatic stage of HIV infection.