Jm. Arduino et al., Do HIV type 1 RNA levels provide additional prognostic value to CD4(+) T lymphocyte counts in patients with advanced HIV type 1 infection?, AIDS RES H, 17(12), 2001, pp. 1099-1105
Our objective was to assess whether HIV-1 RNA levels provide additional pro
gnostic information beyond CD4(+) T lymphocyte counts in the prediction of
subsequent HIV-1 disease progression among patients with advanced HIV-1 dis
ease. In a nested case-control study conducted in patients with baseline CD
4+ T lymphocyte counts < 300 cells/mm(3) and receiving nucleoside reverse t
ranscriptase inhibitors, 102 patients who progressed to an AIDS-defining ev
ent or death were matched within 10 CD4(+) T lymphocyte cells/mm(3) to pati
ents who did not progress. The relationship between plasma HIV-1 RNA levels
and HIV-1 disease progression was studied using conditional logistic regre
ssion analysis, which adjusts for the matching by baseline CD4(+) T lymphoc
ytes. We observed a 0.10 log(10) copies/ml difference in baseline HIV-1 RNA
levels between cases and their matched controls (p = 0.027). The relative
risk for HIV-1 disease progression increased with increasing baseline HIV-1
RNA levels (odds ratio [OR] for a 3-fold higher HIV-1 RNA level, 1.42; 95%
confidence interval [CII, 1.08-1.86), and remained important when also con
trolling for clinical status at baseline and CD4(+) T lymphocytes at 2 mont
hs (p = 0.038). Higher baseline HIV-1 RNA levels were associated with HIV-1
disease progression among patients with a baseline CD4+ T lymphocyte count
of 100 cells/mm(3) or greater (OR, 1.80; 95% CI, 1.15-2.81), but not among
patients with a baseline CD4(+) T lymphocyte count < 100 cells/mm(3) (OR,
1.09; 95% CI, 0.73-1.63). We concluded that HIV-1 RNA levels predict subseq
uent HIV-1 disease progression independent of CD4(+) T lymphocyte counts. T
he magnitude and importance of the prognostic information contained in the
HIV-1 RNA levels appear to depend on the CD4(+) T lymphocyte counts.