The relative prognostic value of plasma HIV RNA levels and CD4 lymphocyte counts in advanced HIV infection

A Cozzi-Lepri; T L Katzenstein; H Ullum; A N Phillips; P Skinhøj; J Gerstoft; Bente Klarlund Pedersen

The relative prognostic value of plasma HIV RNA levels and CD4 lymphocyte counts in advanced HIV infection

A Cozzi-Lepri, T L Katzenstein, H Ullum, A N Phillips, P Skinhøj, J Gerstoft, Bente Klarlund Pedersen

Institut for Klinisk Medicin

73 Citationer (Scopus)

Abstract

OBJECTIVE: It has been suggested that the plasma HIV RNA level is a better predictor of AIDS and death than the CD4 lymphocyte count. We assessed whether the prognostic value of plasma virus levels was different according to the CD4 count.

DESIGN: Prospective cohort study of HIV-infected patients followed for a median of 2.91 years (range, 0.02-4.54).

SETTING: Department of Infectious Diseases at Rigshospitalet, Copenhagen, Denmark.

PARTICIPANTS: A group of 255 HIV-infected individuals with an initial measurement of CD4 lymphocyte count and plasma HIV RNA.

MAIN OUTCOME MEASURE: Survival time.

RESULTS: The plasma HIV RNA (median 101410 copies/ml; range (range 200-7200000) and the CD4 lymphocyte count (median 250 cells x 10(6)/l; range 1-1247) were negatively correlated (Pearson r = -0.53; P < 0.00001). Of the 255 patients, 110 died during follow-up. Overall, a higher HIV RNA level was associated with increased risk of death, but the association was smaller in patients with lower CD4 lymphocyte counts (test for interaction P < 0.0001). In patients with CD4 count below 50 cells x 10(6)/l the association between HIV RNA and risk of death was not statistically significant (relative hazard per 10-fold higher HIV RNA level was 1.53; P = 0.11; adjusted for age and CD4 count) while that between the CD4 count and risk of death was highly significant (relative hazard per 50% lower CD4 count 1.38; P = 0.005; adjusted for age and HIV RNA level).

CONCLUSIONS: Patients were relatively lightly treated with antiretroviral drugs both before and during this study. In this situation, it appears that the HIV RNA level has a relatively weak association with risk of death in patients with advanced HIV infection and that the CD4 lymphocyte count is probably more useful in assessing prognosis.

Originalsprog	Engelsk
Tidsskrift	AIDS (London, England)
Vol/bind	12
Udgave nummer	13
Sider (fra-til)	1639-43
Antal sider	5
ISSN	0269-9370
Status	Udgivet - 10 sep. 1998

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title = "The relative prognostic value of plasma HIV RNA levels and CD4 lymphocyte counts in advanced HIV infection",

abstract = "OBJECTIVE: It has been suggested that the plasma HIV RNA level is a better predictor of AIDS and death than the CD4 lymphocyte count. We assessed whether the prognostic value of plasma virus levels was different according to the CD4 count.DESIGN: Prospective cohort study of HIV-infected patients followed for a median of 2.91 years (range, 0.02-4.54).SETTING: Department of Infectious Diseases at Rigshospitalet, Copenhagen, Denmark.PARTICIPANTS: A group of 255 HIV-infected individuals with an initial measurement of CD4 lymphocyte count and plasma HIV RNA.MAIN OUTCOME MEASURE: Survival time.RESULTS: The plasma HIV RNA (median 101410 copies/ml; range (range 200-7200000) and the CD4 lymphocyte count (median 250 cells x 10(6)/l; range 1-1247) were negatively correlated (Pearson r = -0.53; P < 0.00001). Of the 255 patients, 110 died during follow-up. Overall, a higher HIV RNA level was associated with increased risk of death, but the association was smaller in patients with lower CD4 lymphocyte counts (test for interaction P < 0.0001). In patients with CD4 count below 50 cells x 10(6)/l the association between HIV RNA and risk of death was not statistically significant (relative hazard per 10-fold higher HIV RNA level was 1.53; P = 0.11; adjusted for age and CD4 count) while that between the CD4 count and risk of death was highly significant (relative hazard per 50% lower CD4 count 1.38; P = 0.005; adjusted for age and HIV RNA level).CONCLUSIONS: Patients were relatively lightly treated with antiretroviral drugs both before and during this study. In this situation, it appears that the HIV RNA level has a relatively weak association with risk of death in patients with advanced HIV infection and that the CD4 lymphocyte count is probably more useful in assessing prognosis.",

keywords = "Adult, Aged, Biomarkers, CD4 Lymphocyte Count, Cohort Studies, Female, Follow-Up Studies, HIV, HIV Infections, Humans, Male, Middle Aged, Prognosis, Proportional Hazards Models, RNA, Viral, Viral Load, Journal Article, Research Support, Non-U.S. Gov't",

author = "A Cozzi-Lepri and Katzenstein, {T L} and H Ullum and Phillips, {A N} and P Skinh{\o}j and J Gerstoft and Pedersen, {Bente Klarlund}",

year = "1998",

month = sep,

day = "10",

language = "English",

volume = "12",

pages = "1639--43",

journal = "AIDS, Supplement",

issn = "1350-2840",

publisher = "Lippincott Williams & Wilkins",

number = "13",

}

TY - JOUR

T1 - The relative prognostic value of plasma HIV RNA levels and CD4 lymphocyte counts in advanced HIV infection

AU - Cozzi-Lepri, A

AU - Katzenstein, T L

AU - Ullum, H

AU - Phillips, A N

AU - Skinhøj, P

AU - Gerstoft, J

AU - Pedersen, Bente Klarlund

PY - 1998/9/10

Y1 - 1998/9/10

N2 - OBJECTIVE: It has been suggested that the plasma HIV RNA level is a better predictor of AIDS and death than the CD4 lymphocyte count. We assessed whether the prognostic value of plasma virus levels was different according to the CD4 count.DESIGN: Prospective cohort study of HIV-infected patients followed for a median of 2.91 years (range, 0.02-4.54).SETTING: Department of Infectious Diseases at Rigshospitalet, Copenhagen, Denmark.PARTICIPANTS: A group of 255 HIV-infected individuals with an initial measurement of CD4 lymphocyte count and plasma HIV RNA.MAIN OUTCOME MEASURE: Survival time.RESULTS: The plasma HIV RNA (median 101410 copies/ml; range (range 200-7200000) and the CD4 lymphocyte count (median 250 cells x 10(6)/l; range 1-1247) were negatively correlated (Pearson r = -0.53; P < 0.00001). Of the 255 patients, 110 died during follow-up. Overall, a higher HIV RNA level was associated with increased risk of death, but the association was smaller in patients with lower CD4 lymphocyte counts (test for interaction P < 0.0001). In patients with CD4 count below 50 cells x 10(6)/l the association between HIV RNA and risk of death was not statistically significant (relative hazard per 10-fold higher HIV RNA level was 1.53; P = 0.11; adjusted for age and CD4 count) while that between the CD4 count and risk of death was highly significant (relative hazard per 50% lower CD4 count 1.38; P = 0.005; adjusted for age and HIV RNA level).CONCLUSIONS: Patients were relatively lightly treated with antiretroviral drugs both before and during this study. In this situation, it appears that the HIV RNA level has a relatively weak association with risk of death in patients with advanced HIV infection and that the CD4 lymphocyte count is probably more useful in assessing prognosis.

AB - OBJECTIVE: It has been suggested that the plasma HIV RNA level is a better predictor of AIDS and death than the CD4 lymphocyte count. We assessed whether the prognostic value of plasma virus levels was different according to the CD4 count.DESIGN: Prospective cohort study of HIV-infected patients followed for a median of 2.91 years (range, 0.02-4.54).SETTING: Department of Infectious Diseases at Rigshospitalet, Copenhagen, Denmark.PARTICIPANTS: A group of 255 HIV-infected individuals with an initial measurement of CD4 lymphocyte count and plasma HIV RNA.MAIN OUTCOME MEASURE: Survival time.RESULTS: The plasma HIV RNA (median 101410 copies/ml; range (range 200-7200000) and the CD4 lymphocyte count (median 250 cells x 10(6)/l; range 1-1247) were negatively correlated (Pearson r = -0.53; P < 0.00001). Of the 255 patients, 110 died during follow-up. Overall, a higher HIV RNA level was associated with increased risk of death, but the association was smaller in patients with lower CD4 lymphocyte counts (test for interaction P < 0.0001). In patients with CD4 count below 50 cells x 10(6)/l the association between HIV RNA and risk of death was not statistically significant (relative hazard per 10-fold higher HIV RNA level was 1.53; P = 0.11; adjusted for age and CD4 count) while that between the CD4 count and risk of death was highly significant (relative hazard per 50% lower CD4 count 1.38; P = 0.005; adjusted for age and HIV RNA level).CONCLUSIONS: Patients were relatively lightly treated with antiretroviral drugs both before and during this study. In this situation, it appears that the HIV RNA level has a relatively weak association with risk of death in patients with advanced HIV infection and that the CD4 lymphocyte count is probably more useful in assessing prognosis.

KW - Adult

KW - Aged

KW - Biomarkers

KW - CD4 Lymphocyte Count

KW - Cohort Studies

KW - Female

KW - Follow-Up Studies

KW - HIV

KW - HIV Infections

KW - Humans

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Proportional Hazards Models

KW - RNA, Viral

KW - Viral Load

KW - Journal Article

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

M3 - Journal article

C2 - 9764783

SN - 1350-2840

VL - 12

SP - 1639

EP - 1643

JO - AIDS, Supplement

JF - AIDS, Supplement

IS - 13

ER -

The relative prognostic value of plasma HIV RNA levels and CD4 lymphocyte counts in advanced HIV infection

Abstract

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