HIV 101
From Brown Medical School
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 |
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- 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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