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Strategies for HIV therapy

April 2008 View PDF En español

Chart of the risk of progression to AIDS-defining illness

Some reports show that women progress to HIV disease at a lower viral load than men. While these data do not currently warrant a new standard of care for women with HIV, women and their doctors should be aware of these reports as they may support starting or switching therapy at lower HIV levels than what is currently recommended.

By contrast, CD4+ counts — which provide useful measures for the risk of HIV disease progression — are not influenced by sex. For more information on this issue, call Project Inform’s toll-free hotline at 1-800-822-7422. The chart below presents information on viral load and CD4+ lymphocytes as predictors of HIV-1 infection.

This chart presents information on viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. The table is shown here for ease of use and can also be found as Table 5 on page 46 of the March 23, 2004 issue of the federal Guidelines for the Use of Antiretroviral Agents in HIV-1-infected Adults and Adolescents, or online at www.aidsinfo.nih.gov.

Risk of progression to AIDS-defining illness
in a cohort of gay men predicted by baseline
CD4+ cell count and viral load*

CD4+ cell count < 200 and HIV levels# of …		Percent of AIDS-defining illness‡
bDNA	RT-PCR	n	3 years	6 years	9 years
< 500	< 1,500	0§	—	—	—
501–3,000	1,501–7,000	3§	—	—	—
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	75.0	90.0
> 30,000	> 55,000	70	85.5	97.9	100.0
CD4+ cell count 200–350** and HIV levels† of …		Percent of AIDS-defining illness‡
bDNA	RT-PCR	n	3 years	6 years	9 years
< 500	< 1,500	3§	—	—	—
501–3,000	1,501–7,000	27	0.0	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+ cell count > 350 and HIV levels† of …		Percent of AIDS-defining illness‡
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

* Data from the Multi-Center AIDS Cohort Study (MACS) (Source: J Mellors JW, Rinaldo CR Jr, Gupta P, et. al. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma, Science 1996; adapted by Alvaro Muñoz, PhD, John Hopkins University, 2001)

† MACS numbers reflect viral load values obtained by 2.0 bDNA testing. RT-PCR values are consistently 2-2.5 fold higher than bDNA values, as indicated.

‡ In the reference study, AIDS was defined according to the 1987 CDC definition, which did not include asymptomatic persons with CD4+ cells <200.

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

** A recent evaluation of data from the MACS cohort of 231 persons with CD4+ cell counts >200 and <350 cells demonstrated that of 40 (17%) persons with HIV levels below 10,000, none progressed to AIDS by 3 years (Source: Phair JP, Mellors JW, Detels R, Margolick JB, Muñoz A. Virologic and immunologic values allowing safe deferral of antiretroviral therapy. AIDS 2002; 16(18): 2455–9).). Of 28 persons (29%) with HIV levels of 10,000–20,000, 4% and 11% progressed to AIDS at 2 and 3 years, respectively. Viral load was calculated as RT-PCR values from measured bDNA values.

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