A Clinically Prognostic Scoring System for Patients Receiving Highly Active Antiretroviral Therapy: Results from the EuroSIDA Study [Lindgren JD et al. JID 2002;185:178] The authors define a scoring system to determine the probability of clinical progression of HIV in patients receiving HAART. Results are based on analysis of several variables among 2,027 patients who initiated HAART in 60 centers in Europe and Israel. Clinical progression was defined as an AIDS-defining diagnosis or death. During an average follow-up of 33 months, 200 patients (9.9%) experienced progression. Variables that correlated with progression are summarized in the table below, which also provides the odds ratio for this outcome and the points assigned in the final tabulation of the scoring system.

Variable	Odds Ratio	Points
CD4 count:   >200 cells/mm3   50-200 cells/mm3   <50 cells/mm3	1.0 2.6 9.3	0 3 7
Viral load:   <50 c/ml   500-10,000 c/mL   >10,000 c/mL	1.0 1.3 1.8	0 1 2
Hemoglobin:   >14 (M) > 12 (F)   8-14 g/dL   <8 g/dL	1.0 2.2 7.1	0 2 6
Clinical status   No AIDS dx   AIDS dx <12 mo   Lymphoma or PML	1.0 0.9 1.9	0 0 2

Analysis of three cohorts showed the anticipated direct correlation between score and probability of clinical progression as follows: score 0--1.0/100 patient-years, score 6--12/100 patient-years and score 12 or more--143/100 patient-years.
Comment: There were several scoring systems developed in the pre-HAART era, but this is one of the first and possibly the best since those days. An important advantage is its simplicity. It is somewhat predictable, but a surprise is that AIDS-defining illnesses other than PML and non-Hodgkin's lymphoma did not impart risk. Also of interest is the observation that baseline observations prior to HAART did not seem to provide good prognostic value.
posted 1/28/2002

back to news table of contents