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

J Acquir Immune Defic Syndr. 2010 Sep;55(1):117-27. doi: 10.1097/QAI.0b013e3181e8c129.

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.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acquired Immunodeficiency Syndrome / drug therapy
  • Acquired Immunodeficiency Syndrome / immunology
  • Acquired Immunodeficiency Syndrome / pathology*
  • Acquired Immunodeficiency Syndrome / virology
  • Adolescent
  • Adult
  • Aged
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / methods*
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes / immunology*
  • Female
  • HIV-1 / immunology
  • HIV-1 / isolation & purification*
  • Humans
  • Male
  • Middle Aged
  • RNA, Viral / blood*
  • Risk Factors
  • Viral Load*
  • Young Adult

Substances

  • Anti-HIV Agents
  • RNA, Viral