INDICATORS OF PROGNOSIS IN AIDS


I. Quantitative plasma HIV RNA ("viral load")

  1. Better than CD4 counts for predicting eventual AIDS and/or death in one study (Science 272:1167, 1996) and for predicting progression to AIDS but not death in another (J. Inf. Dis 173:1388, 1996).
  2. Change in viral load with starting new antiretroviral regimens correlates negatively with progression of disease and death (Ann. Int. Med 126:929 and 126:939, 1997-JW)
  3. 1600 men with HIV at all stages of disease followed for mean 10y; viral load at study entry correlated well with rate of CD4 count drop and development of clinical complications of AIDS.
  4. Viral load in first 4 months after infection is not predictive of disease progression (Ann. Int. Med. 128:613, 1998--JW)

II. Age at seroconversion (Lancet 347:1573, 1996)

  1. Studied 1216 hemophiliacs who contracted HIV by transfusion from 8mo to 79yo between 1979 and 1986
  2. Used data on dx of AIDS and death 1985-1992
  3. 86% of those who seroconverted at <15yo were alive 10y after infection vs 12% who seroconverted at >55yo; RR of AIDS dx in 10y was 5 for >55yo c/w <15yo

III. Lowest-ever CD4 count predicts risk of progression to AIDS-defining illness or death in pts with HIV on highly-active antiretroviral therapy (Ann. Int. Med. 130:570, 1999--JW)

IV. CD4 counts, a reliable predictor of disease progression prior to the advent of highly-active antiretroviral therapy, is less reliable in pts receiving such therapy (Lancet 356:291, 2000--JW)