Clinical prognosis of patients with early-stage human immunodeficiency virus (HIV) disease : Contribution of HIV-1 RNA and T lymphocyte subset quantitation

Systems for the staging of individuals with human immunodeficiency virus type 1 (HIV-1) infection were developed 15 years ago. Subsequently, assays for quantitating HIV-1 RNA and immunophenotyping of lymphocyte subsets have been developed and validated. The utility of these assays for improved stagi...

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Published in:Military medicine 2001-07, Vol.166 (7), p.571-576
Main Authors: BROWN, Arthur E, DOLAN, Matthew J, MALONE, John D, GARNER, Robin, BIRX, Deborah L, MICHAEL, Nelson L, ZHOU, Susan, PERFETTO, Stephen P, HAWKES, Clifton, ROBB, Merlin, LANE, James, MAYERS, Douglas, MCNEIL, John G
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Biological and medical sciences
Chi-Square Distribution
Disease Progression
Female
HIV
HIV Infections - immunology
HIV-1
Human immunodeficiency virus
Human viral diseases
Humans
Immune system
Infections
Infectious diseases
Lymphocyte Count
Lymphocytes
Male
Medical prognosis
Medical sciences
Outcome Assessment (Health Care)
Prognosis
Proportional Hazards Models
RNA, Viral - blood
Statistics, Nonparametric
Survival Analysis
T-Lymphocyte Subsets
Vaccines
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:Systems for the staging of individuals with human immunodeficiency virus type 1 (HIV-1) infection were developed 15 years ago. Subsequently, assays for quantitating HIV-1 RNA and immunophenotyping of lymphocyte subsets have been developed and validated. The utility of these assays for improved staging in early disease was evaluated in 256 HIV-infected adults (52% minority) with CD4 counts > or = 400 cells/microL followed in U.S. military medical centers before the highly active anti-retroviral therapy era. HIV viral load (RNA) was quantitated; the frequencies of select CD4+ immunophenotypes were determined in 112 subjects. The results were analyzed in relation to three outcome measures: death, first acquired immunodeficiency syndrome-defining opportunistic infection, and CD4 count < or = 200 cells/microL. Serum RNA level and CD4 count were each found to be predictive of all three outcomes. In addition, increases in the T-cell subsets CD28-CD4+ and CD29+CD26-CD4+ were found to be independently predictive of more rapid progression. The classification of early-stage HIV patients is improved by the quantitation of both viral RNA and T-lymphocyte subsets.
ISSN:0026-4075
1930-613X
DOI:10.1093/milmed/166.7.571