Association of virus load, CD4 cell count, and treatment with clinical progression in human immunodeficiency virus-infected patients with very low CD4 cell counts

This study prospectively assessed the impact of treatment modality, virus load, and CD4 cell count of <50 cells/mm(3) on human immunodeficiency virus disease progression. The incidence rate of new AIDS disease or death was 54.8 (95% confidence interval, 48.7-59.9) per 100 person-years of follow-up. Independent predictors related to progression were latest CD4 cell count (relative risk [RR], 0.84/10 mm(3) higher; P < .0001), latest hemoglobin level (RR, P 0.79/ g/L higher; P < .0001), Pneumocystis carinii pneumonia prophylaxis (RR, 0.49; P <.0001), latest body mass index (RR, 0.93/kg/m(2) higher; P = .002), latest virus load (RR, 1.11/ log(10) higher; P = .03), and intensity of treatment (RR, 1.82, P = .004; RR 2.27, P < .0001;RR 2.46, P = .0001; RR 2.33 P < .0006; 5.10, P < .0001, respectively, for 4, 3, 2, 1, or no drugs vs. >= 5 drugs). Although reverse causality cannot be excluded, more intense antiviral treatment appears to decrease the risk of progression in immunocompromised patients.