Kovacs A, Chan L, Bremer J, Meyer WA, Weiser B, Young M, Hessol N; International Conference on AIDS.

Int Conf AIDS. 1998; 12: 803 (abstract no. 42153).

USC School of Medicine, Los Angeles 90033, USA.

OBJECTIVES: To assess the impact of HIV RNA on CD4 decline and clinical outcome for women enrolled in the Women's Interagency HIV Study (WIHS). METHODS: WIHS is a prospective natural history study with 2,641 (2066 HIV+) women seen every 6 months. Analysis includes 1098 women with > or = three CD4 and RNA levels; 879 (80%) received antiretroviral therapy (treated). Plasma RNA levels were determined using NASBA (undetectable < 4,000 copies/ml). Patients were categorized by highest RNA level over 5 visits (< 4,000, 4-50,000, 50,000 to 1 M and > or = 1 M). Significant RNA change from baseline to Visit 2 was defined as +/- 0.5 log. Analysis of variance was performed. RESULTS: Overall, at the first study visit, mean CD4 was 404 cells/mm3, mean decline was -2 cells/6 m, mean RNA was 101,836 copies/ml (median 16,600). CD4 declined in all RNA groups for untreated women including those with persistently undetectable RNA (-10 to -33 cells/6 mos). Comparing RNA between visits 1 and 2 CD4 declined whether RNA increased, remained stable or decreased (-31, -17, -8 cells/6 mos). Initial CD4 and RNA had an impact on magnitude but not pattern of decline (-11 to -35 cells/mm2). For treated women CD4 increased in those with persistently undetectable RNA (mean +7.6 cells/6 mos) but decreased for those with maximum RNA over 1 M copies/ml (mean -13 cells/6 mos). With a decrease in RNA between visits 1 and 2, CD4 increased (mean +12 cells/6 mos) but with stable or increasing RNA CD4 remained stable over 2 years. CD4 counts remained relatively stable over 2 years (+2 cells/6 mos; +7 cells/6 mos), if initial RNA levels were < 4,000 copies or were persistently low. Clinical outcomes are being studied. CONCLUSION: The course of CD4 change is different for treated and untreated women over the first two years of the WIHS Study. Women who have RNA levels persistently < 4,000 copies/ml continue to have CD4 decline if untreated, but CD4 counts are stable or increase for treated women. With persistently high RNA levels CD4 continues to decline over two years for all women.

Publication Types:

• Meeting Abstracts

Keywords:

• AIDS Vaccines
• Acquired Immunodeficiency Syndrome
• Antigens, CD4
• CD4 Lymphocyte Count
• Female
• HIV Infections
• HIV Seropositivity
• Humans
• Prospective Studies
• RNA
• RNA, Viral
• immunology

Other ID:

• 98403083

UI: 102230952

From Meeting Abstracts