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Brown Medical School
HIV 101
March 2004
Table 1: Helping HIV-Infected Persons Decide When to Start HAART
Modified from the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Recommendations for When to Initiate Antiretroviral Therapy in Chronic HIV Infection, November 10, 2003. |
| Clinical Category | CD4+ T-Cell Count | Plasma HIV RNA | Recommendation |
| Symptomatic (AIDS or severe symptoms) | Any value | Any value | Treat |
| Asymptomatic, AIDS | CD4+ T-cells <200/mm3 | Any value | Treat |
| Asymptomatic | CD4+ T-cells >200/mm3 but <350/mm3 | Any value | Most clinicians recommend offering treatment* |
| Asymptomatic | CD4+ T-cells >350/mm3 | >55,000 (by RT-PCR or bDNA)** | Some clinicians recommend initiating therapy, as the three-year risk for untreated patients to develop AIDS is >30%. Other clinicians recommend deferring therapy and monitoring the CD4+ T-cell count and plasma HIV RNA more frequently. Clinical outcome data after initiating therapy are lacking. |
| Asymptomatic | CD4+ T-cells >350/mm3 | <55,000 (by RT-PCR or bDNA)** | Most clinicians recommend deferring therapy and monitoring the CD4+ T-cell count, as the three-year risk for untreated patients to develop AIDS is <15%. |
| * Clinical benefit has been demonstrated in controlled trials only for patients with CD4+ T-cells <200/mm3.
** Although a 2-2.5 fold difference existed between RT-PCR and the first bDNA assay (version 2.0), with the 3.0 version bDNA assay, values obtained by bDNA and RT-PCR are similar except at the lower end of the linear range (<1,500 copies/mL). |
| Table 2: The Risk for Progression to AIDS-Defining Illness Among a Cohort of Men Not Receiving HAART, Predicted by Baseline CD4+ T-Cell Count and HIV Viral Load |
CD4 <200 cells/mm3
Plasma Viral Load (copies/mL) | Percentage With AIDS-Defining Illness After 3, 6, 9 Years1 |
| bDNA | RT-PCR | n | 3 Years | 6 Years | 9 Years |
| <500 | <1,500 | 02 | - | - | - |
| 501-3,000 | 1,501-7,000 | 32 | - | - | - |
| 3,001-10,000 | 7,001-20,000 | 7 | 14.3 | 28.6 | 64.3 |
| 10,001-30,000 | 20,001-55,000 | 20 | 50.0 | 75 | 90.0 |
| >30,000 | >55,000 | 70 | 85.5 | 97.9 | 100.0 |
CD4 201-3503 cells/mm3
Plasma Viral Load (copies/mL) | Percentage With AIDS-Defining Illness After 3, 6, 9 Years1 |
| bDNA | RT-PCR | n | 3 Years | 6 Years | 9 Years |
| <500 | <1,500 | 32 | - | - | - |
| 501-3,000 | 1,501-7,000 | 27 | 0 | 20.0 | 32.2 |
| 3,001-10,000 | 7,001-20,000 | 44 | 6.9 | 44.4 | 66.2 |
| 10,001-30,000 | 20,001-55,000 | 53 | 36.4 | 72.2 | 84.5 |
| >30,000 | >55,000 | 104 | 64.4 | 89.3 | 92.9 |
CD4 >350 cells/mm3
Plasma Viral Load (copies/mL) | Percentage With AIDS-Defining Illness After 3, 6, 9 Years1 |
| bDNA | RT-PCR | n | 3 Years | 6 Years | 9 Years |
| <500 | <1,500 | 119 | 1.7 | 5.5 | 12.7 |
| 501-3,000 | 1,501-7,000 | 227 | 2.2 | 16.4 | 30.0 |
| 3,001-10,000 | 7,001-20,000 | 342 | 6.8 | 30.1 | 53.5 |
| 10,001-30,000 | 20,001-55,000 | 323 | 14.8 | 51.2 | 73.5 |
| >30,000 | >55,000 | 262 | 39.6 | 71.8 | 85.0 |
- In the reference study, AIDS was defined according to the 1987 CDC definition, which did not include asymptomatic persons with CD4+ T-cells
counts <200 cells/mm3.
- Too few subjects were in the category to provide a reliable estimate of AIDS risk.
- A recent evaluation of data from the (MACS) Multicenter AIDS Cohort Study of 231 persons with CD4+ T-cell counts >200 and <350 cells/mm3 demonstrated that of 40 (17%) persons with plasma HIV RNA <10,000 copies/mL, none progressed to AIDS by 3 years. Of 28 individuals (29%) with plasma viremia of 10,000-20,000 copies/mL, 4% and 11% progressed to AIDS at 2 and 3 years, respectively. Plasma HIV RNA was calculated as RT-PCR values from measured bDNA values.
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This article was provided by Brown Medical School. It is a part of the publication HEPP Report.
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