The relative value od CD4 cell count and quantitative HIV-1 RNA in predicting survival in HIV-1-infected women: results of the women's interagency HIV study

Objectives: To determine factors associated with survival and to assess the relative strength of CD4 cell count and HIV-1 RNA in predicting survival i n a cohort of HIV 1-infected women. Design: Prospective cohort, enrolled during 1994-1995, with median follow-u p of 29 months Results: Of 1769 HIV-infected women 252 died. In multivariate analyses, low er CD4 cell count, higher quantitative plasma HIV-1 RNA, and the presence o f a self-reported AIDS-defining (Class C) condition were significantly asso ciated with shorter survival: the relative hazard (RH) of dying was 1.17, 3 .27, and 8.46, respectively for women with baseline CD4 cell count of 200-3 49, 50-199, and < 50 x 10(6) cells/l, compared with women with CD4 cell cou nt of greater than or equal to 350 x 10(6) cells/l. Compared with women wit h HIV-1 RNA levels of < 4000 copies/ml plasma, the RH of dying for women wi th baseline quantitative HIV-1 RNA:measurements of 4000-20 000, 20 000-100 000, 100 000-500 000 and > 500 000 copies/ml, was 2.19, 2.17, 3.16, and 7.2 5, respectively. CD4 cell count had as strong a prognostic value as HIV-1 R NA level, particularly among participants with more advanced immunodeficien cy. When the analysis was adjusted to eliminate the distortion created by h aving disproportionately sized strata of the categorized variables, the rel ative hazard of death associated with CD4 cell count became even larger in comparison with that for HIV-1 RNA. Eliminating from the analysis all follo w up time during which participants could have received highly active antir etroviral therapy did not change these findings. Age was not a predictor of survival after adjustment for covariates. Conclusions: CD4 cell count and HIV-1 RNA had similar prognostic value in t his cohort of HIV-1-infected women. Even in the presence of a low viral bur den, a substantially decreased CD4 cell count remained a strong predictor o f mortality. (C) 1999 Lippincott Williams & Wilkins.