Association of Virus Load, CD4 Cell Count, and Treatment with Clinical Progression in Human Immunodeficiency Virus-Infected Patients with Very Low CD4 Cell Counts

Miller, Veronica ; Phillips, Andrew N. ; Clotet, Bonaventura ; Mocroft, Amanda ; Ledergerber, Bruno ; Kirk, Ole ; Ormaasen, Vidar ; Gargalianos-Kakolyris, Panagiotis ; Vella, Stefano ; Lundgren, Jens D.

In: The Journal of Infectious Diseases, 2002, vol. 186, no. 2, p. 189-197

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    This study prospectively assessed the impact of treatment modality, virus load, and CD4 cell count of <50 cells/mm3 on human immunodeficiency virus disease progression. The incidence rate of new AIDS disease or death was 54.8 (95% confidence interval, 48.7-59.9) per 100 person-years of follow-up. Independent predictors related to progression were latest CD4 cell count (relative risk [RR], 0.84/10 mm3 higher; P<.0001), latest hemoglobin level (RR, 0.79/g/L higher; P<.0001), Pneumocystis carinii pneumonia prophylaxis (RR, 0.49; P<.0001), latest body mass index (RR, 0.93/kg/m2 higher; P=.002), latest virus load (RR, 1.11/log10 higher; P=.03), and intensity of treatment (RR, 1.82, P=.004; RR 2.27, P<.0001; RR 2.46, P=.0001; RR 2.33 P<.0006; 5.10, P<.0001, respectively, for 4, 3, 2, 1, or no drugs vs. ⩾5 drugs). Although reverse causality cannot be excluded, more intense antiviral treatment appears to decrease the risk of progression in immunocompromised patients