p24 as a predictor of mortality in a cohort of HIV-1-infected adults in rural Africa

TY - JOUR

T1 - p24 as a predictor of mortality in a cohort of HIV-1-infected adults in rural Africa

AU - Erikstrup, Christian

AU - Kallestrup, Per

AU - Zinyama-Gutsire, Rutendo B L

AU - Gomo, Exnevia

AU - Lüneborg-Nielsen, Margrethe

AU - Gerstoft, Jan

AU - Schüpbach, Jörg

AU - Ullum, Henrik

AU - Katzenstein, Terese L

PY - 2008/7/1

Y1 - 2008/7/1

N2 - BACKGROUND: Implementation of antiretroviral treatment in sub-Saharan Africa requires efficient tools to monitor HIV patients. p24 measurements have been proposed as an alternative to HIV-RNA because of the low cost of reagents and equipment needed. Here, we evaluate p24 as a prognostic marker in a cohort of HIV-1-infected individuals in Zimbabwe.METHODS: Treatment-naive HIV-1-infected individuals (n=198) from the Mupfure Schistosomiasis and HIV Cohort were followed until death or censoring (3-4.3 years). At baseline, p24, HIV-RNA, CD4 cell counts, and clinical staging (Centers for Disease Control and Prevention classification) were assessed.RESULTS: p24 correlated with HIV-RNA (P<0.0001, R: 0.44). Ten percent of p24 but only 1% of HIV-RNA measurements was undetectable. p24 predicted Centers for Disease Control and Prevention category (P<0.001) stronger than CD4 count (P=0.34) in multivariate logistic regression. p24 predicted mortality in univariate Cox analysis (P<0.0001) and in multivariate analysis, but it was inferior to HIV-RNA and CD4 count.CONCLUSIONS: This is the first study to evaluate the prognostic strength of p24 in an area with a predominance of HIV subtype C infections. p24 correlated with HIV-RNA and predicted clinical stage better than CD4 count. It predicted mortality in both univariate and multivariate analysis, but in multivariate analysis, it was inferior to HIV-RNA and CD4 count.

AB - BACKGROUND: Implementation of antiretroviral treatment in sub-Saharan Africa requires efficient tools to monitor HIV patients. p24 measurements have been proposed as an alternative to HIV-RNA because of the low cost of reagents and equipment needed. Here, we evaluate p24 as a prognostic marker in a cohort of HIV-1-infected individuals in Zimbabwe.METHODS: Treatment-naive HIV-1-infected individuals (n=198) from the Mupfure Schistosomiasis and HIV Cohort were followed until death or censoring (3-4.3 years). At baseline, p24, HIV-RNA, CD4 cell counts, and clinical staging (Centers for Disease Control and Prevention classification) were assessed.RESULTS: p24 correlated with HIV-RNA (P<0.0001, R: 0.44). Ten percent of p24 but only 1% of HIV-RNA measurements was undetectable. p24 predicted Centers for Disease Control and Prevention category (P<0.001) stronger than CD4 count (P=0.34) in multivariate logistic regression. p24 predicted mortality in univariate Cox analysis (P<0.0001) and in multivariate analysis, but it was inferior to HIV-RNA and CD4 count.CONCLUSIONS: This is the first study to evaluate the prognostic strength of p24 in an area with a predominance of HIV subtype C infections. p24 correlated with HIV-RNA and predicted clinical stage better than CD4 count. It predicted mortality in both univariate and multivariate analysis, but in multivariate analysis, it was inferior to HIV-RNA and CD4 count.

KW - Acquired Immunodeficiency Syndrome

KW - Adult

KW - Biomarkers

KW - CD4 Lymphocyte Count

KW - HIV Core Protein p24

KW - HIV Infections

KW - HIV-1

KW - Humans

KW - Predictive Value of Tests

KW - Prognosis

KW - RNA, Viral

KW - Survival Analysis

KW - Zimbabwe

KW - Evaluation Studies

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1097/QAI.0b013e31817dc3d1

DO - 10.1097/QAI.0b013e31817dc3d1

M3 - Journal article

C2 - 18545150

SN - 1525-4135

VL - 48

SP - 345

EP - 349

JO - J A I D S

JF - J A I D S

IS - 3

ER -