Relationship between CD4+ T-cell counts/HIV-1 RNA plasma viral load and AIDS-defining events among persons followed in the ACTG longitudinal linked randomized trials study.

TitleRelationship between CD4+ T-cell counts/HIV-1 RNA plasma viral load and AIDS-defining events among persons followed in the ACTG longitudinal linked randomized trials study.
Publication TypeJournal Article
Year of Publication2010
AuthorsSmurzynski M, Wu K, Benson CA, Bosch RJ, Collier AC, Koletar SL
JournalJ Acquir Immune Defic Syndr
Volume55
Issue1
Pagination117-27
Date Published2010 Sep
ISSN1944-7884
KeywordsAcquired Immunodeficiency Syndrome, Adolescent, Adult, Aged, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes, Female, HIV-1, Humans, Male, Middle Aged, Risk Factors, RNA, Viral, Viral Load, Young Adult
Abstract

BACKGROUND: AIDS-defining events (ADEs) decreased in the era of highly active antiretroviral therapy but still lead to hospitalizations and deaths. Understanding factors related to ADEs is important to mitigate events.

METHODS: We examined the relationship between demographics, behaviors, comorbidities, laboratory, clinical measurements, and ADEs diagnosed among subjects randomized to antiretroviral treatments (ART)/strategies and followed prospectively. Logistic regression models using generalized estimating equations generated odds ratios (ORs) focusing on the relationship between current CD4 T-cell count (CD4)/HIV-1 RNA viral load (VL) and ADEs in the subsequent 16-week study period.

RESULTS: Among the 2948 subjects in the analysis, overall incidence of ADEs was 1.53 per 100 person-years. Multivariate regression models adjusted for demographics, body mass index, and ADE history. A 6-level time-varying variable examined VL (>100,000 copies/mL, < or =100,000) at CD4 levels (0-50, 51-200, >200 cells/microL); reference level was CD4 >200/VL < or =100,000. Among ART naives, odds of having an ADE in the subsequent 16-week interval were greater among subjects with lower CD4 counts; this relationship was modified by VL level (CD4 < or =50/VL >100,000: OR 37.2; CD4 < or =50/VL < or =100,000: OR 30.5; CD4 51-200/VL >100,000: OR 13.0; CD4 51-200/VL < or =100,000: OR 4.5; all P values <0.001). Similar results were seen among ART-experienced subjects.

CONCLUSIONS: Recent CD4 and VL values are closely associated with development of ADEs even after examining a multitude of potential factors.

DOI10.1097/QAI.0b013e3181e8c129
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID20622677
PubMed Central IDPMC2927805
Grant List1 U01AI068634 / AI / NIAID NIH HHS / United States
5 U01 AI069474 / AI / NIAID NIH HHS / United States
5 U01 AI38855 / AI / NIAID NIH HHS / United States
AI069434 / AI / NIAID NIH HHS / United States
AI68636 / AI / NIAID NIH HHS / United States
AI69432 / AI / NIAID NIH HHS / United States
U01 AI038855 / AI / NIAID NIH HHS / United States
U01 AI038855-08 / AI / NIAID NIH HHS / United States
U01 AI068634 / AI / NIAID NIH HHS / United States
U01 AI068634-01 / AI / NIAID NIH HHS / United States