A CRITICAL-ASSESSMENT OF THE PROGNOSTIC VALUE OF HIV-1 RNA LEVELS ANDCD4(-INFECTED PATIENTS() CELL COUNTS IN HIV)

Objective: To determine to what extent human immunodeficiency type 1 ( HIV-1) RNA levels and CD4(+) cell counts predict clinical outcomes in a general HIV-1-infected population. Methods: Community-based prospect ive study (Swiss HIV Cohort Study) including 394 HIV-1-infected patien ts, randomly selected from 4 strata of CD4(+) cell counts (0 to <0.05, 0.05 to <0.20, 0.20 to <0.50, and greater than or equal to 0.50 X 10( 9)/L). Levels of HIV-1 RNA, CD4(+) cell counts, and other variables we re evaluated from samples collected between 1991 and 1993 for their ab ility to predict death and clinical progression. Results: Patients wer e followed up on average for 29 months. Baseline HIV-1 RNA levels, CD4 (+) cell counts, clinical stage, and beta(2)-microglobulin levels inde pendently predicted survival, whereas only HIV-1 RNA levels and CD4(+) cell counts independently predicted clinical progression. Multivariat e relative hazards (RHs) for death ranged from 1.0 to 5.4 across quart iles of CD4(+) counts, but only from 1.0 to 1.8 across quartiles of HI V-1 RNA. For clinical progression, gradients of risk were similar for CD4(+) counts (1.0-4.2) and for HIV-1 RNA (1.0-3.1). In patients with CD4(+) cell counts less than 0.05 X 10(9)/L, HIV-1 RNA levels predicte d neither death nor clinical progression. Finally, the number of HIV-1 RNA copies per CD4(+) cell was the best predictor of death (multivari ate RH, 1.0-9.7 across quartiles) and clinical progression (multivaria te Conclusions: Levels of HIV-1 RNA and CD4(+) cell counts provided in dependent and complementary information on clinical outcomes. The RNA/ CD4(+) ratio was the best single predictor. In patients who had fewer than 0.05 X 10(9)/L CD4(+) cells, HIV-1 RNA levels had little prognost ic value.