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Prognostic Value of HIV-1 RNA, CD4 Cell Count, and CD4 Cell Count Slope for Progression to AIDS and Death in Untreated HIV-1 Infection
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To the Editor: In a study reporting that plasma human immunodeficiency virus 1 (HIV-1) RNA explains less than 10% of the variability in CD4 cell count slope in patients with untreated HIV-1 infection, Rodríguez et al1 questioned viral replication as the main determinant of progressive immunodeficiency. That study did not include the clinically important outcomes of AIDS or death and did not provide data on variability of CD4 cell count slopes. We therefore evaluated the prognostic strength of HIV-1 RNA, CD4 cell count,2-3 and CD4 cell count slope for clinical outcomes, as well as the variance of CD4 cell count slope.
Methods
The study population comprised 1640 HIV-seropositive participants in the Multicenter AIDS Cohort Study (MACS).4 Baseline was the earliest semiannual visit after the first seropositive visit at which plasma HIV-1 RNA and CD4 cell count were available. Measurement of HIV-1 RNA was obtained by reverse transcriptasepolymerase chain reaction (RT-PCR; Amplicor . . . [Full Text of this Article]
John W. Mellors, MD
mellors@dom.pitt.edu University of Pittsburgh Pittsburgh, Pa
Joseph B. Margolick, MD, PhD
Johns Hopkins University Baltimore, Md
John P. Phair, MD
Northwestern University Chicago, Ill
Charles R. Rinaldo, PhD
University of Pittsburgh Pittsburgh, Pa
Roger Detels, MD, MS
University of California, Los Angeles
Lisa P. Jacobson, ScD;
Alvaro Muñoz, PhD
Johns Hopkins University Baltimore, Md
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