Predictive Value of Immunologic and Virologic Markers After ... : JAIDS Journal of Acquired Immune Deficiency Syndromes (original) (raw)

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Predictive Value of Immunologic and Virologic Markers After Long or Short Duration of HIV-1 Infection

Giorgi, Janis V.†*; Lyles, Robert H.‡§§; Matud, Jose L.*; Yamashita, Traci E.§§; Mellors, John W.§; Hultin, Lance E.*; Jamieson, Beth D.*; Margolick, Joseph B.§§; Rinaldo, Charles R. Jr§; Phair, John P.∥; Detels, Roger¶ for the Multicenter AIDS Cohort Study

*_UCLA School of Medicine and Center for AIDS Research, Los Angeles, California; §§The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; ‡Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia; §University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;∥_Northwestern University School of Medicine, Chicago, Illinois; and ¶UCLA School of Public Health, Los Angeles, California, U.S.A.

†Janis V. Giorgi died on May 30, 2000.

Address correspondence and reprint requests to Beth D. Jamieson, Department of Medicine/Cellular Immunology and Cytometry, 12-236 Factor Building, UCLA School of Medicine, Los Angeles, CA, 900951745, U.S.A.; e-mail: [email protected]

Informed consent was obtained from patients, and human experimentation guidelines of the U.S. Department of Health and Human Services and those of the University of California, Los Angeles were followed.

Manuscript received October 8, 2001; accepted December 7, 2001.

Abstract

Summary:

Laboratory markers that predict HIV-1 disease progression include plasma viral burden, CD4+ T-cell count, and CD38 expression on CD8 T cells. To better understand whether the predictive value of these markers is dependent on how long an individual has been infected, we analyzed data from the Multicenter AIDS Cohort Study early (median = 2.8 years) and late (median = 8.7 years) in the course of infection. Overall, we found that HIV RNA and CD38 levels were similarly predictive of AIDS early on compared with a relatively weaker CD4 cell count signal. Later in the course of infection, CD38 level remained the strongest predictive marker and CD4 cell count registered a marked increase in prognostic power. Among untreated individuals, there was little difference in prognosis (median time to AIDS) associated with given marker values regardless of infection duration. The prognosis given a specific viral load level tended to deteriorate late in the course of infection among those undergoing treatment with monotherapy or combination therapy, however. These data provide a unique historical look at the predictive value and prognostic significance of HIV-1 disease markers at different stages of infection in a large cohort, with direct relevance to current patients who are untreated or for whom treatment is ineffective.