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CD4 cell count is a strong predictor of short-term survival among HIV-infected women

Among women infected with the human immunodeficiency virus (HIV) that causes AIDS, CD4 cell count, an indicator of immune function, is as strong an indicator of short-tem survival as HIV-1 RNA blood levels (viral burden). Even in the presence of a low viral burden, a substantially decreased CD4 cell count remained a strong predictor of mortality, according to recent findings from the Women's Interagency HIV Study (WIHS).

The WIHS is cosponsored by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention. It is a multicenter prospective study of the natural history of HIV-1 infection in women conducted in five U.S. cities: New York City (two sites), Washington, DC, Chicago, Los Angeles, and San Francisco. Every 6 months, enrolled women, many of whom may have been infected for 15 or more years, are interviewed and receive a physical examination.

The goal of this study of 1,769 HIV-infected women enrolled during 1994 and 1995 was to determine the predictive role of CD4 cell count and viral load on short-term survival during the first 2.5 years of followup. During the study period, 252 women died. Lower CD4 cell count, higher quantitative plasma HIV-1 RNA, and the presence of a self-reported AIDS-defining condition were significantly associated with shorter survival. CD4 cell count had as strong a prognostic value as HIV-1 RNA level, particularly among women with more advanced immunodeficiency.

The relative hazard of dying was 1.17, 3.27, and 8.46, respectively, for women with baseline CD4 cell counts of 200-349, 50-199, and less than 50 compared with women who had CD4 cell counts of 350 or more. Compared with women with HIV-1 RNA levels of less than 4,000 copies/ml plasma, the relative hazard of dying for women with baseline HIV-1 RNA measurements of 4,000-20,000, 20,000-100,000, 100,000-500,000 and greater than 500,000 copies/ml, was 2.19, 2.17, 3.16, and 7.25, respectively. Eliminating from the analysis all followup time during which the women could have received highly active antiretroviral therapy did not change the results. These findings differ from several studies of men, in which HIV-1 RNA levels were a stronger predictor of survival than CD4 cell count.

See "The relative value of CD4 cell count and quantitative HIV-1 RNA in predicting survival in HIV-1 infected women: Results of the Women's Interagency HIV Study," by Kathryn Anastos, Leslie A. Kalish, Nancy Hessol, and others, in AIDS 13(13), pp. 1717-1726, 1999.

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