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© 1998 Oxford University Press

research-article

Predictive value of viral load and other markers for progression to clinical AIDS after CD4+ cell count falls below 200/µL

N Carréa, F Boufassaa, JB Huberta, M Chavanceb, C Rouziouxc, C Goujardd, Y Lauriane, L Meyera and the SEROCO & HEMOCO Study Groupf

aINSERM U292, Secteur Bleu ‘Pierre-Marie’ Porte 26. 82 Rue du Général Leclerc. 94276, Hôpital de Blcêtre Le Kremlin-Bicetre, France
bINSERM U169, Hôpltal Paul Brousse Villejuif. France
cService de virologle. Hôpital Nerker Paris. France
dService de médedne interne. Hôpital de Bicetre Le Kremlin-Bicetre, France
eCentre de Traltement de I'Hémophille. Hôpital de Bicetre Le Kremlin Bicetre, France
fSee Appendix

BACKGROUND: To assess the predictive value of biological and clinical events for progression to AIDS (1993 European classification) when the CD4+ cell count falls below 200/µL (CD4 threshold) irs different exposure groups. To investigate whether such markers remain predictive independently of the serum HIV-1 RNA level at the CD4 threshold.

METHODS: The predictive value of biological and clinical events occurring during the 24 months prior to the occurrence of CD4 threshold (n=333) was quantified in a Cox model. Another Cox model was carried out iii a subset of 77 patients in whom viral load from stored sera was available. Furthermore, changes in viral load during the 24 months preceding the CD4 threshold were assessed in a mixed model according to subsequent development of AIDS.

RESULTS: Among the 333 patients, the slope of the CD4+ cell counts, the emergence of p24 antigen, persistent thrush, and age at the CD4 threshold were independent predictors of progression to clinical AIDS (44.7%). Among the subset of 77 patients, the HIV- 1 RNA level at the CD4 threshold, persistent thrush arid age remained independent predictors of progression to AIDS (45.5%). The increase of the HIV-1 RNA level was moderate, both in non-progressors (24.0% per year) and in those who subsequently developed AIDS (27.1% per year), (P=0.93). Viral load wasconsistently higher lit the latter group (P=0.002).

CONCLUSION: At a late stage of infection, age and persistent thrush remain predictive of progression to AIDS, independently of viral load.

Keywords CD4 <200/µL, AIDS onset, markers, viral load, exposure groups

Accepted 23 January 1998


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