Predictors of HIV-1 Disease Progression in Early- and Late-Stage Patients: TheU.S. Army Natural History Cohort

摘要

HIV-infected individuals in both early and late stages of HIV disease wereevaluated over 2 years to assess temporal trends and determinants of disease progression. The Walter Reed (WR) staging system was used to categorize patients into an early-stage cohort (WR Stages 1 and 2, N = 1183) and a late-stage cohort (WR Stage 5, N = 260) based on the initial clinical evaluation. Progression was defined as the occurrence of Stage 5 disease or beyond for the early cohort and Stage 6 disease or beyond for the late cohort. The cumulative incidence of progression was 15.7% (137 events) for the early-stage cohort, and 53.7% (85 events) for the late-stage cohort. Baseline CD4+ T lymphocyte (T4) count was the most significant marker of progression: 26% of WR Stage 1 or 2 patients with T4 lymphocytes below 500/MM3 progressed, compared with 12% with T4 lymphocytes at or above 500/mm 3. In late-stage individuals, 83% with T4 lymphocytes under 200/MM3 progressed, compared with 27% with T4 lymphocytes at or above 200/MM3. older age