Clinical prognostic value of RNA viral load and CD4 cell counts during untreated HIV-1 infection : a quantitative review

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dc.contributor.authorKorenromp, Eline L.en_ZA
dc.contributor.authorWilliams, Brian G.en_ZA
dc.contributor.authorSchmid, George P.en_ZA
dc.contributor.authorDye, Christopheren_ZA
dc.date.accessioned2011-05-15T16:00:15Z
dc.date.available2011-05-15T16:00:15Z
dc.date.issued2009-16-07
dc.descriptionCITATION: Korenromp, E. L., Williams, B. G., Schmid, G. P. & Dye, C. 2009. Clinical prognostic value of RNA viral load and CD4 cell counts during untreated HIV-1 infection : a quantitative review. PLoS ONE, 4(6): e5950, doi:10.1371/journal.pone.0005950.
dc.descriptionThe original publication is available at http://journals.plos.org/plosone
dc.description.abstractBackground: The prognostic value of CD4 counts and RNA viral load for identifying treatment need in HIV-infected individuals depends on (a) variation within and among individuals, and (b) relative risks of clinical progression per unit CD4 or RNA difference. Methodology/Principal Findings: We reviewed these measurements across (a) 30 studies, and (b) 16 cohorts of untreated seropositive adults. Median within-population interquartile ranges were 74,000 copies/mL for RNA with no significant change during the course of infection; and 330 cells/μL for CD4, with a slight proportional increase over infection. Applying measurement and physiological fluctuations observed on chronically infected patients, we estimate that 45% of population-level variation in RNA, and 25% of variation in CD4, were due to within-patient fluctuations. Comparing a patient with RNA at upper 75th centile with a patient at median RNA, 5-year relative risks were 1.4 (95% CI 1.2-1.7) for AIDS and 1.5 (1.3-1.9) for death, without change over the course of infection. In contrast, for a patient with CD4 count at the lower 75th centile, relative risks increased from 1.0 at seroconversion to maxima of 6.3 (4.4-8.9) for AIDS and 5.5 (2.7-10.1) for death by year 6, when the population median had fallen to 300 cells/ μL. Below 300 cells/μL, prognostic power did not increase, due to a narrower CD4 range. Conclusions: Findings support the current WHO recommendation (used with clinical criteria) to start antiretroviral treatment in low-income settings at CD4 thresholds of 200-350 cells/μL, without pre-treatment RNA monitoring - while not precluding earlier treatment based on clinical, socio-demographic or public health criteria. © 2009 Korenromp et al.
dc.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0005950
dc.description.versionPublisher's version
dc.format.extent12 pages
dc.identifier.citationKorenromp, E. L., Williams, B. G., Schmid, G. P. & Dye, C. 2009. Clinical prognostic value of RNA viral load and CD4 cell counts during untreated HIV-1 infection : a quantitative review. PLoS ONE, 4(6): e5950, doi:10.1371/journal.pone.0005950.
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0005950
dc.identifier.urihttp://hdl.handle.net/10019.1/11608
dc.language.isoen
dc.publisherPublic Library of Science
dc.rights.holderAuthors retain copyright
dc.subjectHIV infectionsen_ZA
dc.titleClinical prognostic value of RNA viral load and CD4 cell counts during untreated HIV-1 infection : a quantitative reviewen_ZA
dc.typeArticle
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