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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 CategoryCD4+ T-Cell CountPlasma HIV RNARecommendation
Symptomatic (AIDS or severe symptoms)Any valueAny valueTreat
Asymptomatic, AIDSCD4+ T-cells <200/mm3Any valueTreat
AsymptomaticCD4+ T-cells >200/mm3 but <350/mm3Any valueMost clinicians recommend offering treatment*
AsymptomaticCD4+ 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.
AsymptomaticCD4+ 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
bDNART-PCRn3 Years6 Years9 Years
<500<1,50002---
501-3,0001,501-7,00032---
3,001-10,0007,001-20,000714.328.664.3
10,001-30,00020,001-55,0002050.07590.0
>30,000>55,0007085.597.9100.0
CD4 201-3503 cells/mm3
Plasma Viral Load (copies/mL)
Percentage With AIDS-Defining Illness After 3, 6, 9 Years1
bDNART-PCRn3 Years6 Years9 Years
<500<1,50032---
501-3,0001,501-7,00027020.032.2
3,001-10,0007,001-20,000446.944.466.2
10,001-30,00020,001-55,0005336.472.284.5
>30,000>55,00010464.489.392.9
CD4 >350 cells/mm3
Plasma Viral Load (copies/mL)
Percentage With AIDS-Defining Illness After 3, 6, 9 Years1
bDNART-PCRn3 Years6 Years9 Years
<500<1,5001191.75.512.7
501-3,0001,501-7,0002272.216.430.0
3,001-10,0007,001-20,0003426.830.153.5
10,001-30,00020,001-55,00032314.851.273.5
>30,000>55,00026239.671.885.0

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  1. 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.

  2. Too few subjects were in the category to provide a reliable estimate of AIDS risk.

  3. 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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