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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/01.QAI.0000017998.56638.8E
Articles: PDF Only

Predictive Value of HIV-1 Viral Load on Risk for Opportunistic Infection.

Swindells, Susan; Evans, Scott; Zackin, Robert; Goldman, Mitchell; Haubrich, Richard; Filler, Scott G.; Balfour, Henry H. Jr.; for the AIDS Clinical Trial Group 722 Study Team

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Abstract

Objective: The relationship between HIV-1 viral load and the risk for opportunistic infection (OI) was examined in Adult AIDS Clinical Trial Group (AACTG) 722, a virology substudy of AACTG 323: a phase 4 randomized study designed to examine the use of chronic suppressive versus episodic fluconazole therapy.

Methods: The primary analysis used a case-control sampling scheme with two controls per "case" (subjects that developed an OI) matched by gender, age, and time on study. Forty-five cases and matched controls were identified and used in the analysis.

Results: Study 722 accrued 518 subjects between 5/97 and 11/99. Forty-five subjects developed serious OIs or refractory candidiasis. Median baseline CD4 count was 24 cell/mm3 for cases and 46 for controls (p = .003). Median viral load (VL) was 5.02 log10 copies/mL for cases and 4.08 for controls (p = .002). Multivariate analysis found four independent variables associated with time to OI: baseline VL and CD4 (RR = 2.2 per log increment and 6.0 per 50-cell increment, respectively), a one log increase in VL at any time (RR = 15), and history of an OI (RR = 5.2).

Conclusions: VL and changes in VL were independently associated with risk of development of OIs in a prospective study and should be considered by clinicians when assessing patients for risk of OI.

(C) 2002 Lippincott Williams & Wilkins, Inc.

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