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Abstract
EARLY HIV-1 DNA LEVEL PREDICTS DISEASE PROGRESSION AND DEATH INDEPENDENTLY OF HIV-RNA LEVEL AND CD4 CELL COUNT.
ROUZIOUX C
Objective: To evaluate the prognostic value of early HIV-1 DNA levels on disease progression and death.
405 HIV(+) adults enrolled in 1988 in the prospective SEROCO cohort within 2 years after a documented date of infection and before the initiation of any antiretroviral therapy. PBMC and serum samples were stored at enrollment, within 6 months after infection (median 3.8) for 113 patients and during the 6-24 months period (median 11.6) for 292 patients. HIV DNA in PBMC and HIV RNA in serum were quantified using HIV-1 Monitor test. Cox models were used to assess the predictive value of markers, the outcome measures were clinical AIDS (1993 European definition) death or CD4<200/µL. None of the patients had received HAART before the cut-off date for analysis (March, 31, 1996).
In the 6-24 month period, HIV DNA (median 2.87 log/106PBMC 2.45-3.25), HIV RNA (median 4.00 log, 3.57-4.45) and CD4 count were independent predictors of time to AIDS. The predictive value of HIV DNA was higher than those of HIV RNA and CD4 count: adjusted relative risk (RR) for a one log increase was 3.3 (1.6-5.9) and 1.7 (1.1-2.6) respectively ; adjusted RR for a 100 CD4 decrease was 1.12 (1.02-1.24). Similar results were found for time to death and for having CD4 <200/µL. Adjustment for age, gender and symptomatic primary infection did not modify these results. Among individuals with moderate HIV-RNA <30.000 cp/mL and CD4 count >350/µL (n=149), HIV-DNA level clearly distinguished those with a high risk of progression: probability of AIDS at 6 years was 8% in patients with HIV-DNA <750 cp/106PBMC and 33% in those with >750 cp/106PBMC (Log-Rank test: p<0.0001). In the 0-6 month period, only HIV-DNA level was a strong and independent predictor of progression: adjusted RR=4,2 (1.7-10.2) versus 1.4 (0.7-2.5) for HIV RNA and 1.1 (0.9-1.2) for CD4.
Conclusion : HIV DNA is the best predictor of disease progression; it should help on the difficult decision when to start antiretroviral therapy.
The 1st. IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
23
Suggested Citation
"ROUZIOUX C
EARLY HIV-1 DNA LEVEL PREDICTS DISEASE PROGRESSION AND DEATH INDEPENDENTLY OF HIV-RNA LEVEL AND CD4 CELL COUNT..
Oral Presentation:
The 1st. IAS Conference on HIV Pathogenesis and Treatment
:
Abstract no.
23"
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