Objective: To characterize the progression to HIV-1 disease among injecting drug users (IDU) according to laboratory markers. Design: Prospective study of cohort of HIV-1-seroprevalent IDU, with case-comparison component. Methods: Different laboratory markers were examined as predictors of progression to HIV-1-associated diseases including AIDS in a cohort of 318 HIV-1-infected IDU. The cohort was enrolled from a methadone treatment program in the Bronx, New York, USA. The independent utility of non-CD4 cell markers was evaluated after adjustment for the association of low CD4 lymphocyte count with AIDS risk. Clinical events in the natural history of HIV-1 were related to changes in levels of two variables related to duration of infection, CD4 lymphocyte count and serum β2-microglobulin (β2M) concentration. Results: On univariate analysis, AIDS incidence measured from baseline increased with declining CD4 lymphocyte number and percentage, increasing serum β2M level, low platelet count, low leukocyte count and p24 antigenemia. Among HIV-1-related outcomes prior to any AIDS diagnosis, the relative risk of pyogenic bacterial infections conferred by these markers was similar to the relative risk of AIDS. For all HIV-1 outcomes, the elevated risk encountered at CD4 lymphocyte number ≤ 200 x 106/l was entirely due to the high risk at ≤ 150 x 106/l. On multivariate analysis, control for CD4 lymphocyte count eliminated the association of any other marker with increased AIDS hazard. HIV-1-related outcomes tended to occur in this order: multiple constitutional symptoms, oral candidiasis, pyogenic bacterial infections and AIDS. Conclusions: In HIV-1-infected IDU, several laboratory markers may predict AIDS when analyzed individually. These are not, however, independently related to increased AIDS risk after adjustment for low CD4 lymphocyte count. A CD4 count ≤ 150 x 106/l is more strongly related to immediate risk of adverse outcome than a count of 200 x 106/l. A progressive series of clinical events is associated with markers of duration of HIV-1 infection, prior to and including AIDS diagnosis.
|Original language||English (US)|
|Number of pages||9|
|Publication status||Published - Jan 1 1994|
- CD4 lymphocytes
ASJC Scopus subject areas
- Immunology and Allergy
- Infectious Diseases