[16] VIRAL LOAD, PERCENTAGE CD4 CELL COUNT AND SURVIVAL IN HIV MONOTYPIC AND DUAL INFECTIONS IN WEST AFRICA

1st International AIDS Society Conference on HIV Pathogenesis and Treatment

Buenos Aires, Argentina - July 8-11, 2001

[TITLE:] VIRAL LOAD, PERCENTAGE CD4 CELL COUNT AND SURVIVAL IN HIV MONOTYPIC AND DUAL INFECTIONS IN WEST AFRICA

[AUTHOR(S):] Alabi S, Blanchard T, Shabbar J, Corrah T, Ariyoshi K, Berry N, Whittle H
MRC Laboratories, Banjul, Gambia

IAS Conf HIV Pathog Treat 2001 Jul 8-11;1st: Abstract No. 16

[ABSTRACT:] Background: Studies from developed countries have shown plasma viraemia as an excellent maker of prognosis in HIV-1 infections. However, it is not known whether plasma viraemia is an independent predictor of mortality in HIV-1 infected African people, or how the death rates in HIV-1 and HIV-2 differ after taking plasma viraemia and percentage CD4 cell count (CD4%) into account. This hospital-based study addresses these questions.

Methods: We measured baseline plasma viraemia (RNA copies/ml) in a total of 256 (119 HIV-1 and 137 HIV-2) singly infected and 81 individuals dually infected with both viruses (HIV-D). Subjects were part of a clinical cohort of HIV infected individuals seen at our clinic, enrolled between 1991 and 1997, and followed-up through 2000. Survival was established by home visits if subjects did not present to clinic during a quarterly check-up schedule. HIV status was established by serology and by PCR; and CD4% was measured by FACScan.

Results: HIV-1 plasma viraemia among singly infected individuals were similar to that of dually infected (p=0.5), and similar trend for HIV-2 (p=0.7). Mean CD4% was significantly lower in dual infections than in either HIV-1 or HIV-2 infected subjects. Death rates of dually infected subjects were significantly higher than that in HIV-2 but similar to that in HIV-1 with hazard ratios (95% CI) of 1.54 (1.08, 2.19; p=0.02) and 1.25 (0.88, 1.77; p=0.2) respectively.

Conclusions: Both plasma viraemia and CD4% were independently associated with survival in HIV-2 infection, while only CD4% was independently associated with survival in HIV-1 and in dual infections. After adjusting for plasma viraemia and CD4%, survival in HIV-1 or HIV-2 infected individuals did not differ significantly. Our findings give new insight into how these two viruses differ; and may provide the means with which patients are better counselled about their prognosis, and by which therapies might be tested and monitored.

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