Relation between CD4 cell counts and HIV RNA levels at onset of opportunistic infections

Objective: To evaluate the relation between CD4 and HIV RNA levels at the o nset of specific opportunistic infections (OIs) in HIV-infected patients. Design and Methods: The OIs occurring between June 1996 and December 1998 w ere retrospectively reviewed, considering only the episodes of major and mi ner OIs in patients with simultaneously available CD4 and plasma HIV RNA de terminations before clinical onset who had been untreated or on stable anti retroviral therapy (ART) for at least 2 months. Results: Two hundred seventy-four episodes of different OIs were considered in 216 patients; the median CD4 count was 35 cells/mm(3) (range: 0-1154 ce lls/mm(3)), and the median HIV RNA count was 5.1 log cp/mL (range: <1.9-6.7 log copies/ml). The different HN RNA levels were significantly associated with different OIs regardless of CD4 and ART (p < .0001), even when only th ose occurring in patients with a CD4 count of less than or equal to 50 cell s/mm(3) were considered (p = .0049). Kaposi sarcoma, esophageal candidiasis , oropharyngeal candidiasis, and Mycobacterium avium complex disease were a ssociated with significantly above-average median HIV RNA levels, and varic ella-zoster virus infection was associated with below-average levels. Conclusions: Different OIs are associated at their onset with significantly different HN RNA levels, regardless of CD4 cell counts and ART.