The relative value of CD4 cell count and quantitative HIV-1 RNA in predicting survival in HIV-1-infected women: Results of the women's interagency HIV study

Kathryn Anastos, Leslie A. Kalish, Nancy Hessol, Barbara Weiser, Sandra Melnick, David Burns, Robert Delapenha, Jack DeHovitz, Mardge Cohen, William Meyer, James Bremer, Andrea Kovacs

Research output: Contribution to journalArticlepeer-review

50 Scopus citations

Abstract

Objectives: To determine factors associated with survival and to assess the relative strength of CD4 cell count and HIV-1 RNA in predicting survival in a cohort of HIV-1-infected women. Design: Prospective cohort, enrolled during 1994-1995, with median follow-up of 29 months Results: Of 1769 HIV-infected women 252 died. In multivariate analyses, lower CD4 cell count, higher quantitative plasma HIV-1 RNA, and the presence of a self-reported AIDS-defining (Class C) condition were significantly associated with shorter survival: the relative hazard (RH) of dying was 1.17, 3.27, and 8.46, respectively for women with baseline CD4 cell count of 200-349, 50-199, and < 50 x 106 cells/l, compared with women with CD4 cell count of ≥ 350 x 106 cells/l. Compared with women with HIV-1 RNA levels of < 4000 copies/ml plasma, the RH of dying for women with baseline quantitative HIV-1 RNA measurements of 4000-20,000, 20,000-100,000, 100,000-500,000 and > 500,000 copies/ml, was 2.19, 2.17, 3.16, and 7.25, respectively. CD4 cell count had as strong a prognostic value as HIV-1 RNA level, particularly among participants with more advanced immunodeficiency. When the analysis was adjusted to eliminate the distortion created by having disproportionately sized strata of the categorized variables, the relative hazard of death associated with CD4 cell count became even larger in comparison with that for HIV-1 RNA. Eliminating from the analysis all follow-up time during which participants could have received highly active antiretroviral therapy did not change these findings. Age was not a predictor of survival after adjustment for covariates.

Original languageEnglish (US)
Pages (from-to)1717-1726
Number of pages10
JournalAIDS
Volume13
Issue number13
DOIs
StatePublished - 1999

Keywords

  • CD4 cell count
  • HIV
  • HIV-1 RNA
  • Survival
  • Women

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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