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HIV 101

March 2004

Table 1: Helping HIV-Infected Persons Decide When to Start HAART
Table 2: The Risk for Progression to AIDS-Defining Illness Among a Cohort of Men Not Receiving HAART, Predicted by Baseline CD4+ T-Cell Count and HIV Viral Load

Table 1: Helping HIV-Infected Persons Decide When to Start HAART Modified from the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Recommendations for When to Initiate Antiretroviral Therapy in Chronic HIV Infection, November 10, 2003.
Clinical Category	CD4+ T-Cell Count	Plasma HIV RNA	Recommendation
Symptomatic (AIDS or severe symptoms)	Any value	Any value	Treat
Asymptomatic, AIDS	CD4+ T-cells <200/mm³	Any value	Treat
Asymptomatic	CD4+ T-cells >200/mm³ but <350/mm³	Any value	Most clinicians recommend offering treatment*
Asymptomatic	CD4+ T-cells >350/mm³	>55,000 (by RT-PCR or bDNA)**	Some clinicians recommend initiating therapy, as the three-year risk for untreated patients to develop AIDS is >30%. Other clinicians recommend deferring therapy and monitoring the CD4+ T-cell count and plasma HIV RNA more frequently. Clinical outcome data after initiating therapy are lacking.
Asymptomatic	CD4+ T-cells >350/mm³	<55,000 (by RT-PCR or bDNA)**	Most clinicians recommend deferring therapy and monitoring the CD4+ T-cell count, as the three-year risk for untreated patients to develop AIDS is <15%.
* Clinical benefit has been demonstrated in controlled trials only for patients with CD4+ T-cells <200/mm³. ** Although a 2-2.5 fold difference existed between RT-PCR and the first bDNA assay (version 2.0), with the 3.0 version bDNA assay, values obtained by bDNA and RT-PCR are similar except at the lower end of the linear range (<1,500 copies/mL).

Table 2: The Risk for Progression to AIDS-Defining Illness Among a Cohort of Men Not Receiving HAART, Predicted by Baseline CD4+ T-Cell Count and HIV Viral Load
CD4 <200 cells/mm³ Plasma Viral Load (copies/mL)		Percentage With AIDS-Defining Illness After 3, 6, 9 Years¹
bDNA	RT-PCR	n	3 Years	6 Years	9 Years
<500	<1,500	0²	-	-	-
501-3,000	1,501-7,000	3²	-	-	-
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	90.0
>30,000	>55,000	70	85.5	97.9	100.0
CD4 201-350³ cells/mm³ Plasma Viral Load (copies/mL)		Percentage With AIDS-Defining Illness After 3, 6, 9 Years¹
bDNA	RT-PCR	n	3 Years	6 Years	9 Years
<500	<1,500	3²	-	-	-
501-3,000	1,501-7,000	27	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 >350 cells/mm³ Plasma Viral Load (copies/mL)		Percentage With AIDS-Defining Illness After 3, 6, 9 Years¹
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
In the reference study, AIDS was defined according to the 1987 CDC definition, which did not include asymptomatic persons with CD4+ T-cells counts <200 cells/mm³. Too few subjects were in the category to provide a reliable estimate of AIDS risk. A recent evaluation of data from the (MACS) Multicenter AIDS Cohort Study of 231 persons with CD4+ T-cell counts >200 and <350 cells/mm³ demonstrated that of 40 (17%) persons with plasma HIV RNA <10,000 copies/mL, none progressed to AIDS by 3 years. Of 28 individuals (29%) with plasma viremia of 10,000-20,000 copies/mL, 4% and 11% progressed to AIDS at 2 and 3 years, respectively. Plasma HIV RNA was calculated as RT-PCR values from measured bDNA values.

This article was provided by Brown Medical School. It is a part of the publication HEPP Report.

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