Relation Between CD4 Cell Counts and HIV RNA Levels at Onset of Opportunistic Infections [Brambilla AM et al. JAIDS 2001; 27: 44]: This is a study from Milan to determine the relation between CD4 cell counts and HIV RNA levels at the time of onset of specific OIs. There were a total of 274 opportunistic infections in 216 patients. The median CD4 cell count was 35/mm³ and the median viral load was 5.1 log 10 c/mL. As expected, the most frequent OIs (CMV, MAC, thrush, PCP, esophageal candidiasis and toxoplasmosis) clustered in the group that had CD4 counts <50 cells/mm³, the median CD4 cell counts were higher for PML - 71 cells/mm³, bacterial pneumonia - 114 cells/mm³, TB - 144 cells/mm³, lymphoma - 268 cells/mm³ and zoster - 210 cells/mm³. Within the group that had CD4 counts <50 cells/mm³, the viral load measurement was significantly higher for KS, esophageal candidiasis, thrush and disseminated MAC. By contrast, many episodes of zoster and some cases of bacterial pneumonia, toxoplasmosis, TB, PML, lymphoma and CMV occurred even when the viral load was undetectable. The authors conclude that different OIs show significant differences in terms of probability with varying HIV RNA levels, and this effect is independent of the CD4 cell count.
Comment: Prior studies have suggested that the viral load plays an important role in prevention of OIs, independent of the CD4 cell count [JAMA 1996;276:105; AIDS 1999;13:341; AIDS 1999;13:1035]. The present report supports these observations and also suggests that there may be variation among the different OIs in this relationship.
posted 7/3/2001

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