Lower CD4 cell count and higher virus load, but not antiretroviral drug resistance, are associated with AIDS-defining events and mortality: an ACTG Longitudinal Linked Randomized Trials (ALLRT) analysis.

TitleLower CD4 cell count and higher virus load, but not antiretroviral drug resistance, are associated with AIDS-defining events and mortality: an ACTG Longitudinal Linked Randomized Trials (ALLRT) analysis.
Publication TypeJournal Article
Year of Publication2011
AuthorsSwindells S, Jiang H, A Mukherjee L, Winters M, Bosch RJ, Katzenstein D
JournalHIV Clin Trials
Volume12
Issue2
Pagination79-88
Date Published2011 Mar-Apr
ISSN1528-4336
KeywordsAcquired Immunodeficiency Syndrome, Adult, Case-Control Studies, CD4 Lymphocyte Count, Drug Resistance, Viral, Female, Humans, Logistic Models, Longitudinal Studies, Male, Randomized Controlled Trials as Topic, Retrospective Studies, Viral Load
Abstract

BACKGROUND: We hypothesized that drug resistance mutations would impact clinical outcomes associated with HIV-1 infection.

METHODS: A matched case-control study of participants in AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT). Cases experienced an AIDS-defining event (ADE) or mortality, and controls did not. One hundred thirty-four cases were identified and matched to a total of 266 controls by age, sex, treatment regimen, and length of follow-up. Both cases and controls had HIV RNA levels of ≥ 500 copies/mL within 24 weeks of an event. Population-based genotyping at or near the time of the event was used to evaluate the impact of resistance mutations on incidence of ADE and/or death using conditional logistic regression models.

RESULTS: One hundred four cases and 183 controls were analyzed. Median time to event was 99 weeks; 6 cases were deaths. At baseline, cases had lower CD4 (median 117 vs 235 cells/mm3; P < .0001) and higher HIV RNA levels (median 205,000 vs 57,000 copies/mL; P = .003). No significant differences in resistance were seen between cases and controls.

CONCLUSIONS: In this rigorously designed case-control study, lower CD4 cell counts and higher virus loads, not antiretroviral drug resistance, were strongly associated with ADE and mortality.

DOI10.1310/hct1202-79
Alternate JournalHIV Clin Trials
PubMed ID21498151
PubMed Central IDPMC3320087
Grant ListAI38855 / AI / NIAID NIH HHS / United States
AI38858 / AI / NIAID NIH HHS / United States
AI68634 / AI / NIAID NIH HHS / United States
AI68636 / AI / NIAID NIH HHS / United States
AI69450 / AI / NIAID NIH HHS / United States
U01 AI038855 / AI / NIAID NIH HHS / United States
U01 AI038855-04 / AI / NIAID NIH HHS / United States
U01 AI038858 / AI / NIAID NIH HHS / United States
U01 AI038858-04 / AI / NIAID NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068634-01 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 AI068636-01 / AI / NIAID NIH HHS / United States
U01 AI069450 / AI / NIAID NIH HHS / United States
U01 AI069450-01 / AI / NIAID NIH HHS / United States