Mortality Risk in HIV-1 Infected Children

 

Baseline Values

 

Observations:

(1) baseline values of percent CD4 lymphocytes < 15% do poorly

(2) baseline values of HIV-1 RNA copies per mL > 1,000,000 do poorly

(3) baseline values of HIV-1 RNA copies per mL > 100,000 do worse than those <= 100,000

 

Relative risk:

(1) 2.1 for baseline RNA levels > 100,000 copies/mL

(2) 3.0 for baseline CD4 cell percent < 15%

 

5 year survival based on baseline values

Parameter	Value	5 year survival rate
HIV-1 RNA level in copies/mL	<= 10,000	86%
	10,001 - 100,000	82%
	100,001 - 1,000,000	77%
	> 1,000,000	35%
percent CD4 lymphocytes	>= 15%	86%
	< 15%	37%

data extracted from Figure 3, page 1034

 

baseline HIV-1 RNA levels in copies per mL plasma	baseline CD4 lymphocyte percent	mortality rate	5 year survival rate
<= 100,000	>= 15%	low	92%
> 100,000	>= 15%	low intermediate	79%
<= 100,000	< 15%	high intermediate	42%
> 100,000	< 15%	high	33%

from Table 5 page 1036, and Figure 3 page 1034

 

Values over Course of Infection

 

Relative risk:

(1) 1.8 if RNA levels increases after baseline

(2) 2.8 if CD4 cell percent drops to < 15%

 

The change in HIV-1 RNA plasma levels:

(1) relative risk increases by 2.75 for each log10 increase in HIV-1 RNA

(2) for implementation, set relative risk to 1 for values with log10 <= 1

 

The change in percent CD4 lymphocytes:

(1) relative risk increases by 1.33 for each 5% decrease

(2) for implementation, set relative risk to 1 for values with percent decrease <= 3.8%

 

Limitations:

• Use of newer antiretroviral agents that greatly reduce plasma HIV-1 RNA levels may affect survival but probably not the relative relationships between baseline groups.