Clinical Manual for Management of the HIV-Infected ... - myCME.com

Determining Risk of HIV Progression
Background
The absolute CD4 cell count and CD4 percentage
are used for disease staging, and to determine when
to start antiretroviral therapy (ART) and prophylaxis
against opportunistic infections. The HIV RNA level
(viral load), when used in conjunction with the CD4
count, also provides prognostic information in patients
who are naive to ART.
Table 1. Relationship between CD4 Count or Viral Load and
AIDS Progression
CD4 Count
(cells/µL)
Viral Load
(copies/mL)
AIDS Progression
in Men (%)
Over 3 Years Over 9 Years
350 30,000 40% 85%
Adapted from: Mellors JW, Rinaldo CR Jr, Gupta P, et al. Prognosis in HIV-1 infection predicted
by the quantity of virus in plasma. Science. 1996 May 24;272(5265):1167-70.
Section 1—Testing and Assessment | 1–27
Data from various cohort studies have demonstrated
the strong relationship between lower CD4 count or
higher viral load and the risk of progression to AIDS.
Tables 1 and 2 and Figure 1 below show the risk of
disease progression and death in patients who have not
been treated with ART and in patients starting ART
in several North American, European, and Australian
cohorts. The data consistently indicate the importance
of initiating ART before the CD4 count declines to