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1996-03-04
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Document 0627
DOCN M9640627
TI Changes in plasma HIV-1 RNA and CD4+ lymphocyte counts and the risk of
progression to AIDS. Veterans Affairs Cooperative Study Group on AIDS.
DT 9604
AU O'Brien WA; Hartigan PM; Martin D; Esinhart J; Hill A; Benoit S; Rubin
M; Simberkoff MS; Hamilton JD; Department of Medicine, West Los Angeles
Veterans Affairs Medical; Center, CA 90073, USA.
SO N Engl J Med. 1996 Feb 15;334(7):426-31. Unique Identifier : AIDSLINE
MED/96150231
AB BACKGROUND. Clinical trials of antiretroviral drugs can take years to
complete because the outcomes measured are progression to the acquired
immunodeficiency syndrome (AIDS) or death. Trials could be accelerated
by the use of end points such as changes in CD4+ lymphocyte counts and
plasma levels of human immunodeficiency virus type 1 (HIV-1) RNA and
beta 2-microglobulin, but there is uncertainty about whether these
surrogate measures are valid predictors of disease progression. METHODS.
We analyzed data from the Veterans Affairs Cooperative Study on AIDS,
which compared immediate with deferred zidovudine therapy. Patients'
plasma levels of HIV-1 RNA and beta 2-microglobulin were measured in
stored plasma. RESULTS. Among the 129 patients in the
immediate-treatment group, 34 had disease that progressed to AIDS, as
compared with 57 of the 141 patients in the deferred-treatment group (P
= 0.03). Progression to AIDS correlated strongly with base-line CD4+
lymphocyte counts (P = 0.001) and plasma levels of HIV-1 RNA (P <
0.001), but not with base-line levels of beta 2-microglobulin (P =
0.14). A decrease of at least 75 percent in the plasma level of HIV-1
RNA over the first six months of zidovudine therapy accounted for 59
percent of the benefit of treatment, defined as the absence of
progression to AIDS (95 percent confidence interval, 13 to 112 percent).
Plasma beta 2-microglobulin levels and CD4+ lymphocyte counts explained
less of the effect of treatment. A 75 percent decrease in the plasma
HIV-1 RNA level plus a 10 percent increase in the CD4+ lymphocyte count
could explain 79 percent of the treatment effect (95 percent confidence
interval, 27 to 145 percent). CONCLUSIONS. Treatment-induced changes in
the plasma HIV-1 RNA level and the CD4+ lymphocyte count, taken
together, are valid predictors of the clinical progression of
HIV-related disease and can be used to assess the efficacy of zidovudine
and possibly other antiretroviral drugs as well.
DE beta 2-Microglobulin/ANALYSIS Acquired Immunodeficiency
Syndrome/IMMUNOLOGY/*PHYSIOPATHOLOGY/ VIROLOGY Antiviral
Agents/*THERAPEUTIC USE Biological Markers/BLOOD *CD4 Lymphocyte
Count/DRUG EFFECTS Disease Progression Human HIV Infections/*DRUG
THERAPY/IMMUNOLOGY/PHYSIOPATHOLOGY/VIROLOGY HIV-1/GENETICS/*ISOLATION &
PURIF Life Tables *Outcome Assessment (Health Care) Regression
Analysis Retrospective Studies Risk RNA, Viral/*BLOOD Support,
Non-U.S. Gov't Support, U.S. Gov't, Non-P.H.S. Zidovudine/*THERAPEUTIC
USE JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).