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Ongoing changes in HIV RNA levels during untreated HIV infection: implications for CD4 cell count depletion

Phillips, AN; Lampe, FC; Smith, CJ; Geretti, AM; Rodger, A; Lodwick, RK; Cambiano, V; ... Johnson, MA; + view all (2010) Ongoing changes in HIV RNA levels during untreated HIV infection: implications for CD4 cell count depletion. AIDS , 24 (10) 1561 - 1567. 10.1097/QAD.0b013e32833a6056.

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Abstract

Background: Understanding of the interplay between plasma HIV RNA level and CD4 cell count depletion in untreated infection remains incomplete.Methods: We studied 1169 people with HIV seen for care at a major London clinic while naive to antiretroviral therapy. We considered pairs (n = 5940) of consecutive simultaneously measured CD4 cell count and plasma HIV RNA values from patients who had never started therapy. Baseline was the first date when both measures were known.Results: HIV RNA levels increased variably and often substantially from baseline (60% experience an increase of over 50 000 copies/ml by 5 years of follow-up). The current HIV RNA level (i.e. first value of the pair) was strongly associated with the time-standardized change in CD4 cell count, with a mean 106 cells/mu l per year greater rate of CD4 cell count decline per log-copy/ml higher current HIV RNA level (P < 0.0001). After adjustment for the current level, higher baseline HIV RNA was not associated with CD4 cell count decline. There was no average CD4 cell count decline with current HIV RNA level below 3.0 log-copies/ml, compared with a 159 cells/mu l per year decline for those with HIV RNA at least 5.5 log-copies/ml (P < 0.0001). Further, the current CD4 cell count predicted subsequent changes in HIV RNA level (0.04 log-copies/year greater increases per 100 cells/mu l lower CD4 cell count; P < 0.0001).Conclusion: The often substantial increases in HIV RNA level observed in untreated HIV infection appear fundamentally linked to CD4 cell count depletion. Research into mechanisms by which HIV RNA levels rise over time should yield insights into the causes of CD4 cell count depletion, as the two processes are intimately linked. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Type: Article
Title: Ongoing changes in HIV RNA levels during untreated HIV infection: implications for CD4 cell count depletion
DOI: 10.1097/QAD.0b013e32833a6056
Keywords: CD4 cell count, HIV, HIV RNA, immunodeficiency, natural history, pathogenesis, set point, viral load, IMMUNODEFICIENCY-VIRUS-INFECTION, ANTIRETROVIRAL THERAPY, LYMPHOCYTE COUNTS, VIRAL LOAD, HIV-1-INFECTED PATIENTS, TYPE-1 RNA, SEROCONVERSION, DECLINE, AIDS, INDIVIDUALS
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/138507
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