Variation in Plasma RNA Levels, CD4 Cell Counts, and p24 Antigen Levels in Clinically Stable Men with Human Immunodeficiency Virus Infection

Raboud, Janet; Montaner, Julio S. G.; Conway, Brian; Haley, L.; Sherlock, Christopher H.; O'Shaughnessy, M. V.; Schechter, Mauro

doi:10.1093/infdis/174.1.191

Cited by 68 publications

(47 citation statements)

References 6 publications

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“…Intraindividual variability in CD4 cell counts and viral load can be quite substantial, 29 and the signal-to-noise ratio associated with these measurements may have obscured correlations in the short follow-up time examined by Rodriguez et al 22 Our analysis incorporated a longer follow-up time, and all viral load tests were conducted at a single laboratory. We also were able to reliably exclude any results obtained after the initiation of ART, because our program is the only source of antiretroviral drugs in British Columbia.…”

Section: Discussionmentioning

confidence: 99%

Association Between HIV-1 RNA Level and CD4 Cell Count Among Untreated HIV-Infected Individuals

Lima¹,

Fink²,

Yip³

et al. 2009

Am J Public Health

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Objectives. We examined the significance of plasma HIV-1 RNA levels (or viral load alone) in predicting CD4 cell decline in untreated HIV-infected individuals. Methods. Data were obtained from the British Columbia Centre for Excellence in HIV/AIDS. Participants included all residents who ever had a viral load determination in the province and who had never taken antiretroviral drugs (N = 890). We analyzed a total of 2074 viral load measurements and 2332 CD4 cell counts. Linear mixed-effects models were used to predict CD4 cell decline over time. Results. Longitudinal viral load was strongly associated with CD4 cell decline over time; an average of 1 log10 increase in viral load was associated with a 55-cell/mm3 decrease in CD4 cell count. Conclusions. Our results support the combined use of CD4 cell count and viral load as prognostic markers in HIV-infected individuals before the introduction of antiretroviral therapy.

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Section: Discussionmentioning

confidence: 99%

Association Between HIV-1 RNA Level and CD4 Cell Count Among Untreated HIV-Infected Individuals

Lima¹,

Fink²,

Yip³

et al. 2009

Am J Public Health

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“…A significant decrease in CD4 T lymphocyte count is a decrease of >30% from baseline for absolute cell numbers and a decrease of >3% from + baseline in percentages of cells (3,4). Discordance between trends in CD4 T cell numbers and plasma HIV RNA levels can occur and was found in 20% of patients in one cohort studied (5). Such discordance can complicate decisions regarding antiretroviral therapy and may be due to a number of factors that affect plasma HIV RNA testing (see Principle 2).…”

Section: Use Of Testing For Plasma Hiv Rna Levels and Cd4 + T Cell Comentioning

confidence: 89%

Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents

1998

Ann Intern Med

801

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SummaryThe availability of an increasing number of antiretroviral agents and the rapid evolution of new information has introduced extraordinary complexity into the treatment of HIV-infected persons. In 1996, the Department of Health and Human Services and the Henry J. Kaiser Family Foundation convened the Panel on Clinical Practices for the Treatment of HIV to develop guidelines for the clinical management of HIV-infected adults and adolescents.This report recommends that care should be supervised by an expert, and makes recommendations for laboratory monitoring with particular emphasis on measurement of plasma levels of HIV RNA. The report also provides guidelines for antiretroviral therapy, including when to start treatment, what drugs to initiate, when to change therapy, and therapeutic options when changing therapy. Special considerations are provided for adolescents and pregnant women. As with treatment of other chronic conditions, therapeutic decisions require a mutual understanding between the patient and the health care provider regarding the benefits and risks of treatment. Like the treatment of most chronic diseases, antiretroviral regimens are complex, have major side effects, pose difficulty with compliance, and carry serious potential consequences with the risk of resistance from non-adherence to the drug regimen or suboptimal levels of antiretroviral agents. Patient education and involvement in therapeutic decisions is important for all medical conditions, but is considered especially critical for HIV infection and its treatment.With regard to specific recommendations, treatment should be offered to all patients with the acute HIV syndrome, those within six months of seroconversion, and all patients with symptoms ascribed to HIV infection. Recommendations for offering antiretroviral therapy in asymptomatic patients depend on virologic and immunologic factors. In general, treatment should be + 3 offered to individuals with fewer than 500 CD4 T cells/mm or plasma HIV RNA levels exceeding 10,000 copies/ml (bDNA assay) or 20,000 copies/ml (RT-PCR assay). The strength of the recommendation to treat asymptomatic patients should be based on the patient's willingness to accept therapy, the probability of adherence with the prescribed regimen, and the prognosis in terms of time to an + AIDS-defining complication as predicted by plasma HIV RNA levels and CD4 T cell counts, which independently help to predict prognosis. Once the decision has been made to initiate antiretroviral therapy, the goal is maximum viral suppression for as long as possible. Results of clinical trials to date indicate that this may currently be best achieved with a potent protease inhibitor (PI) in combination with two nucleoside analogue reverse transcriptase inhibitors (NRTIs). Another option is the combination of saquinavir plus ritonavir combined with one or two NRTIs. Other currently available regimens may be used in selected settings, but are considered by many to be less likely to produce maximum viral suppression. Results of t...

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“…A substantial decrease in CD4 ϩ T lymphocyte count is a decrease of Ͼ30% from baseline for absolute cell numbers and a decrease of Ͼ3% from baseline in percentages of cells (7). Discordance between trends in CD4 ϩ T cell numbers and plasma HIV RNA levels was documented among 20% of patients in one cohort studied (8). Such discordance can complicate decisions regarding antiretroviral therapy and might be caused by factors that affect plasma HIV RNA testing.…”

Section: T Cell Count To Guide Decisions Regarding Therapymentioning

confidence: 94%

Guidelines for Using Antiretroviral Agents among HIV-Infected Adults and Adolescents: The Panel on Clinical Practices for Treatment of HIV*

et al. 2002

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Variation in Plasma RNA Levels, CD4 Cell Counts, and p24 Antigen Levels in Clinically Stable Men with Human Immunodeficiency Virus Infection

Cited by 68 publications

References 6 publications

Association Between HIV-1 RNA Level and CD4 Cell Count Among Untreated HIV-Infected Individuals

Association Between HIV-1 RNA Level and CD4 Cell Count Among Untreated HIV-Infected Individuals

Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents

Guidelines for Using Antiretroviral Agents among HIV-Infected Adults and Adolescents: The Panel on Clinical Practices for Treatment of HIV*

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