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

• 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
• ISSN: 0026-4075; 1930-613X
• DOI: 10.1093/milmed/166.7.571

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.