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Abstract
HIV replicative capacity is an independent predictor of disease progression in persons with untreated chronic HIV infection
Goetz M.1, Leduc R.2, Kostman J.3, Labriola A.4, Lie Y.5, Weidler J.5, Coakley E.5, Luskin-Hawk R.6, Long Term Monitoring (LTM) Study, Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA 060)
Objectives: We assessed the effect of replicative capacity (RC) on progression to a composite outcome of CD4+ count <350, treatment initiation or death in prospectively followed, treatment-naïve HIV-infected patients.
Methods: At entry, eligible patients were treatment-naïve and had ³450 CD4+ cells/mL and a viral load (VL) of ³1,000 HIV RNA copies/mL. RC and viral tropism (VT) were assessed using the PhenoSense and Trofile assays (Monogram Biosciences).
Results: Baseline RC results were available for 274 patients. These were divided into three equally sized groups (G). G1, G2 and G3 had RC values of <62, 62-£103, and >103; median CD4 counts of 656, 638 and 567; and median log10 VL of 4.20, 4.22 and 4.22.
After adjusting for age, gender, race, IDU, MSM contact, HBV and/or HCV seropositivity, known duration of HIV infection and prior AIDS diagnoses, the relative risk (RR) of progression was 0.59 for G1 (p=0.02, versus G3), 0.87 per 50 cell higher CD4+ count (p<0.001) and 2.36 per 1.0 log10 higher VL (p<0.001). On a continuous scale the RR was 1.21 (p=0.004) for each 50 point increase in RC. The effect of G1 vs G3 was significant in separate analyses of time to treatment (RR=0.58, p=0.03) but not of time to CD4+ count <350 (RR=0.66, p=0.14).
Finally, for the 248 persons for whom VT results were available, the risk of progression to the composite outcome remained significantly less for G1 (RR=0.60; p=0.032 versus G3) after also controlling for R5 VT (RR=0.46, p=0.007 vs dual/mixed VT).
Conclusion: In these treatment-naïve patients, increased RC was associated with an increased rate of progression to a composite outcome of CD4+ count <350, treatment initiation or death. Compared with an RC >103, the effect of an RC<62 was similar to that of having 50 fewer CD4+ cells, but less than that of a one log10 increase in VL.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
Abstract no.
WEPDB07
Suggested Citation
"GoetzM., et al.
HIV replicative capacity is an independent predictor of disease progression in persons with untreated chronic HIV infection.
Poster discussion:
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention:
Abstract no.
WEPDB07"
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