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Viral load measures just after seroconversion predict disease progression, independent of CD4
The bDNA assay was used for this study. When the analysis was done, only the 1st generation bDNA assay, which measures only as low as 10,000 copies was available. Therefore, the plasma negative group are those individuals that had below 10,000 copies and the plasma positive group is those that had above 10,000 RNA copies. Since this analysis was completed, the 2nd generation bDNA test has become available, which measures as low as 500 copies; and, by looking at additional data, using the more sensitive assay, similar conclusions have been reached (discussed later in this article), that define a lower limit, of 20-30,000 RNA copies, that may indicate a more rapid progression. Baseline RNA measures were those obtained shortly after seroconversion.
Proportion of Patients Developing AIDS
| Plasma Neg. for HIV-1 RNA | Plasma Pos. for HIV-1 RNA |
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| CD4 Count at Seroconv. Cells/mm3 | year 0-1 | year 0-2 | year 0-1 | year 0-2 |
| * >500 | 11% | 6% | 33% | 45% |
| * <500 | 25% | 0% | 56% | 86% |
Individuals who had below or above 500 CD4, and had either no virus detected in their plasma (plasma neg.) by the bDNA assay (meaning below 10,000) or who had consistently greater than 10,000 copies (plasma pos.), had very different progression rates to the development of AIDS. Individuals who consistently had less than 10,000 RNA copies had very low rates (6% and 0%) and individuals consistently above 10,000 had very high rates of progression and these differences were significant.
In fact, this study showed, that using the bDNA assay, individuals with more than 100,000 had a 10 times greater risk of developing AIDS within the next 5 years, than those individuals with under 10,000 copies; and, importantly these conclusions are independent of the CD4 count; that is, whether your CD4 was below or above 500, the rates of progression between the two groups (plasma pos. & plasma neg.) were significantly different.
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About the author: Jules Levin is the Executive Director of NATAP, based in New York City.
The National AIDS Treatment Advocacy Project (NATAP) is a New York State non-profit corporation dedicated to facilitating the effort for development of effective treatment for HIV.
Last modified 9/3/96
by Jules Levin
Copyright © 1996 natap
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