Predictive value of quantitative plasma HIV RNA and CD4+ lymphocyte count in HIV-infected infants and children

JAMA. 1998 Mar 11;279(10):756-61. doi: 10.1001/jama.279.10.756.


Context: Pediatric human immunodeficiency virus (HIV) infection has unique viral pathogenetic features that preclude routine extrapolation from adult studies and require specific analysis.

Objectives: To evaluate the prognostic value of 2 key laboratory markers-plasma RNA and CD4+ lymphocyte count-for HIV disease progression in infants and children and to establish targeted values for optimal outcome.

Design: Data from a cohort of 566 infants and children who participated in a randomized, placebo-controlled trial of nucleoside reverse transcriptase inhibitors (ACTG 152) were analyzed. The trial was conducted between 1991 and 1995 and enrolled a heterogeneous cohort of antiretroviral therapy-naive children (age, 3 months to 18 years); patients had a median follow-up of 32 months.

Main outcome measures: The trial clinical end points consisted of time to first HIV disease progression (growth failure, decline in neurologic or neurodevelopmental function, opportunistic infections) or death.

Results: Baseline plasma RNA levels were high (age group medians, 5 x 10(4) to >10(6) copies/mL), and both baseline RNA and CD4+ lymphocyte count were independently predictive of subsequent clinical course. Risk reduction for disease progression between 49% and 64% was observed for each log10 reduction in baseline RNA and was linear without suggestion of a threshold or age effect. Disease progression predictive power was enhanced by the combined use of plasma RNA and CD4+ cell count. Marker values of less than 10000 copies/mL for plasma RNA and greater than 500 x 10(6)/L (<6.5 years of age) or greater than 200 x 10(6)/L (>6.5 years) for CD4+ cell count were associated with a 2-year disease progression rate of less than 5%.

Conclusions: Two key laboratory markers--plasma RNA and CD4+ lymphocyte count-are independent predictors of clinical course among HIV-infected infants and children. The linear, age-independent relationship between log10 plasma RNA and relative risk of disease progression strongly supports therapeutic efforts to achieve plasma virus levels as low as possible.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Anti-HIV Agents / therapeutic use
  • CD4 Lymphocyte Count*
  • Child
  • Child, Preschool
  • Disease Progression
  • HIV / genetics
  • HIV Infections / blood*
  • HIV Infections / drug therapy
  • HIV Infections / mortality
  • HIV Infections / physiopathology*
  • Humans
  • Infant
  • Prognosis
  • Proportional Hazards Models
  • RNA, Viral / blood
  • Randomized Controlled Trials as Topic
  • Reverse Transcriptase Inhibitors / therapeutic use
  • Survival Analysis
  • Viral Load*


  • Anti-HIV Agents
  • RNA, Viral
  • Reverse Transcriptase Inhibitors