Plasma RNA viral load predicts the rate of CD4 T cell decline and death in HIV-2-infected patients in West Africa

Objective: To examine whether the levels of plasma RNA and DNA provirus predict the rate of CD4 cell decline and patient death. Design: Retrospective analysis of HIV-2 cohort subjects. Methods: Fifty-two subjects were recruited between January 1991 and December 1992. HIV-2 RNA levels in plasma and DNA levels in peripheral blood mononuclear cells (PBMC) were measured using in-house quantitative PCR assays. The annual rate of CD4 cell decline was calculated using the least-squares method. The survival data on 31 December 1997 were used. Results: The mean percentage of CD4 cells at baseline was 30.7 (SD, 9.5). In a linear regression model, the annual rate of CD I cell decline was 1.76 CD4% faster for every increase in one log(10) RNA copies/ml [95% confidence interval (CI), 0.81-2.7; P = 0.0006; r = 0.46; n = 52] and 1.76 CD4% faster for every increase in log(10) DNA copies/10(5) PBMC (95% CI 0.46-3,1; P = 0.01; r = 0.33; n = 42). In a multiple linear regression model, RNA load was related to CD4 decline independently of DNA load (P = 0.02). The overall mortality rate was 7.29/100 person-years. In a Cox regression model, the hazard rate increased by 2.12 for each log(10) increase in RNA load (95% CI, 1.3-3.5; P = 0.0023) but only by 1.09 for each log(10) increase in DNA load (95% CI, 0.64-1.87; P = 0.8). Conclusion: This longitudinal study shows for the first time that a baseline HIV-2 RNA load predicts the rate of disease progression. HIV-2-infected patients with a high viral load may need to be treated as vigorously as HIV-1 patients. (C) 2000 Lippincott Williams & Wilkins.