Abstract
Objective: To determine if HIV-1 RNA and CD4 lymphocyte thresholds for the initiation of highly active antiretroviral therapy (HAART) are associated with clinical response to therapy. Design: Observational cohort study. Setting: Johns Hopkins Hospital HIV Clinic. Patients: HIV-infected adults. Intervention: Patients initiating HAART (n = 530) were compared with concurrent patients who did not receive HAART (n = 484). Main outcome measure: Progression to a new AIDS-defining illness or death. Results: The average duration of follow-up for the cohort was 22 months. HAART resulted in decreased disease progression among persons with fewer than, but not more than, 200 × 106 CD4 lymphocytes/l prior to treatment. Among persons receiving HAART, plasma HIV-1 RNA level prior to therapy was not associated with HIV disease progression within CD4 T-lymphocyte count strata. In a Cox multivariate proportional hazards model that adjusted for age, sex, race, prior opportunistic infection, and CD4 T lymphocytes, ≤ 200 × 106 CD4 lymphocytes/l was the strongest predictor of disease progression. HIV-1 RNA level prior to starting HAART of <5000 copies/ml, 5001-55 000 copies/ml, or > 55 000 copies/ml was not associated with disease progression on therapy, particularly among persons with > 200 × 106 CD4 lymphocytes/l. There was no sex difference in disease progression on treatment. Conclusions: Our data suggest that current guidelines for initiating HAART should place greater emphasis on CD4 lymphocyte than HIV-1 RNA level for both men and women. Further longitudinal follow-up will be needed to better ascertain whether HAART initiated at > 200 × 106 CD4 lymphocytes/l is effective in slowing disease progression.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2251-2257 |
| Number of pages | 7 |
| Journal | AIDS |
| Volume | 15 |
| Issue number | 17 |
| DOIs | |
| State | Published - Nov 23 2001 |
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Keywords
- AIDS
- Antiretroviral therapy
- CD4 cells
- HIV-1
- HIV-1 RNA
- Plasma viral load
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
Cite this
HIV-1 RNA, CD4 T-lymphocytes, and clinical response to highly active antiretroviral therapy. / Sterling, Timothy R.; Chaisson, Richard E; Moore, Richard D.
In: AIDS, Vol. 15, No. 17, 23.11.2001, p. 2251-2257.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - HIV-1 RNA, CD4 T-lymphocytes, and clinical response to highly active antiretroviral therapy
AU - Sterling, Timothy R.
AU - Chaisson, Richard E
AU - Moore, Richard D
PY - 2001/11/23
Y1 - 2001/11/23
N2 - Objective: To determine if HIV-1 RNA and CD4 lymphocyte thresholds for the initiation of highly active antiretroviral therapy (HAART) are associated with clinical response to therapy. Design: Observational cohort study. Setting: Johns Hopkins Hospital HIV Clinic. Patients: HIV-infected adults. Intervention: Patients initiating HAART (n = 530) were compared with concurrent patients who did not receive HAART (n = 484). Main outcome measure: Progression to a new AIDS-defining illness or death. Results: The average duration of follow-up for the cohort was 22 months. HAART resulted in decreased disease progression among persons with fewer than, but not more than, 200 × 106 CD4 lymphocytes/l prior to treatment. Among persons receiving HAART, plasma HIV-1 RNA level prior to therapy was not associated with HIV disease progression within CD4 T-lymphocyte count strata. In a Cox multivariate proportional hazards model that adjusted for age, sex, race, prior opportunistic infection, and CD4 T lymphocytes, ≤ 200 × 106 CD4 lymphocytes/l was the strongest predictor of disease progression. HIV-1 RNA level prior to starting HAART of <5000 copies/ml, 5001-55 000 copies/ml, or > 55 000 copies/ml was not associated with disease progression on therapy, particularly among persons with > 200 × 106 CD4 lymphocytes/l. There was no sex difference in disease progression on treatment. Conclusions: Our data suggest that current guidelines for initiating HAART should place greater emphasis on CD4 lymphocyte than HIV-1 RNA level for both men and women. Further longitudinal follow-up will be needed to better ascertain whether HAART initiated at > 200 × 106 CD4 lymphocytes/l is effective in slowing disease progression.
AB - Objective: To determine if HIV-1 RNA and CD4 lymphocyte thresholds for the initiation of highly active antiretroviral therapy (HAART) are associated with clinical response to therapy. Design: Observational cohort study. Setting: Johns Hopkins Hospital HIV Clinic. Patients: HIV-infected adults. Intervention: Patients initiating HAART (n = 530) were compared with concurrent patients who did not receive HAART (n = 484). Main outcome measure: Progression to a new AIDS-defining illness or death. Results: The average duration of follow-up for the cohort was 22 months. HAART resulted in decreased disease progression among persons with fewer than, but not more than, 200 × 106 CD4 lymphocytes/l prior to treatment. Among persons receiving HAART, plasma HIV-1 RNA level prior to therapy was not associated with HIV disease progression within CD4 T-lymphocyte count strata. In a Cox multivariate proportional hazards model that adjusted for age, sex, race, prior opportunistic infection, and CD4 T lymphocytes, ≤ 200 × 106 CD4 lymphocytes/l was the strongest predictor of disease progression. HIV-1 RNA level prior to starting HAART of <5000 copies/ml, 5001-55 000 copies/ml, or > 55 000 copies/ml was not associated with disease progression on therapy, particularly among persons with > 200 × 106 CD4 lymphocytes/l. There was no sex difference in disease progression on treatment. Conclusions: Our data suggest that current guidelines for initiating HAART should place greater emphasis on CD4 lymphocyte than HIV-1 RNA level for both men and women. Further longitudinal follow-up will be needed to better ascertain whether HAART initiated at > 200 × 106 CD4 lymphocytes/l is effective in slowing disease progression.
KW - AIDS
KW - Antiretroviral therapy
KW - CD4 cells
KW - HIV-1
KW - HIV-1 RNA
KW - Plasma viral load
UR - http://www.scopus.com/inward/record.url?scp=0035941382&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035941382&partnerID=8YFLogxK
U2 - 10.1097/00002030-200111230-00006
DO - 10.1097/00002030-200111230-00006
M3 - Article
C2 - 11698698
AN - SCOPUS:0035941382
VL - 15
SP - 2251
EP - 2257
JO - AIDS
JF - AIDS
SN - 0269-9370
IS - 17
ER -