SynthesisPloS one2009
Clinical prognostic value of RNA viral load and CD4 cell counts during untreated HIV-1 infection--a quantitative review.
Synthesis in PloS one, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
39 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- CD4 enumeration technologies: a systematic review of test performance for determining eligibility for antiretroviral therapy.PloS one · 2015Pooled it
- Antiretroviral therapy for prevention of tuberculosis in adults with HIV: a systematic review and meta-analysis.PLoS medicine · 2012Pooled it
- A phase IIa trial of the new tuberculosis vaccine, MVA85A, in HIV- and/or Mycobacterium tuberculosis-infected adults.American journal of respiratory and critical care medicine · 2012Trial
- Thromboinflammatory biomarkers and thrombotic risk in virologic failure and drug-resistant HIV: Emerging roles of d-dimer, fibrinogen, and coagulation dysregulation.Journal of thrombosis and thrombolysis · 2026Review
- Factors Associated With Viral Suppression Among People Living With HIV (PLWH) in Kermanshah, Iran: A Retrospective Cohort Study.Health science reports · 2026Article
- Optimizing personalized screening intervals for clinical biomarkers using extended joint models.Journal of applied statistics · 2026Article
- CD4 cell count and viral load count association and its joint risk factors among adult TB/HIV co-infected patients: a retrospective follow-up study.BMC research notes · 2025Article
- Electrochemical microfluidic biosensor for the detection of CD4Microsystems & nanoengineering · 2025Article
- Flow-Cytometry Intracellular Detection and Quantification of HIV1 p24 Antigen and Immunocheckpoint Molecules in T Cells among HIV/AIDS Patients.HIV/AIDS (Auckland, N.Z.) · 2022Article
- Modelling of viral load dynamics and CD4 cell count progression in an antiretroviral naive cohort: using a joint linear mixed and multistate Markov model.BMC infectious diseases · 2020Article
- How to Evolve the Response to the Global HIV Epidemic With New Metrics and Targets Based on Pre-Treatment CD4 Counts.Current HIV/AIDS reports · 2019Review
- Trends in CD4 cell count response to first-line antiretroviral treatment in HIV-positive patients from Asia, 2003-2013: TREAT Asia HIV Observational Database Low Intensity Transfer.International journal of STD & AIDS · 2017Article
- Prevalence ofThe American journal of tropical medicine and hygiene · 2017Article
- Demographic and clinical correlates of HIV-1 RNA levels in antiretroviral therapy-naive adults attending a tertiary hospital in Jos, Nigeria.Journal of virus eradication · 2017Article
- Evolution of HIV virulence in response to widespread scale up of antiretroviral therapy: a modeling study.Virus evolution · 2016Article
- Prognostic Value of HIV-1 RNA on CD4 Trajectories and Disease Progression Among Antiretroviral-Naive HIV-Infected Adults in Botswana: A Joint Modeling Analysis.AIDS research and human retroviruses · 2016Article
- CD4 Cell Count: Declining Value for Antiretroviral Therapy Eligibility.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Article
- Emerging technologies for the clinical microbiology laboratory.Clinical microbiology reviews · 2014Review
- An HIV epidemic model based on viral load dynamics: value in assessing empirical trends in HIV virulence and community viral load.PLoS computational biology · 2014Article
- Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe prognostic value of CD4 counts and RNA viral load for identifying treatment need in HIV-infected individuals depends on (a) variation within and among individuals, and (b) relative risks of clinical progression per unit CD4 or RNA difference. METHODOLOGY/PRINCIPAL
findingsWe reviewed these measurements across (a) 30 studies, and (b) 16 cohorts of untreated seropositive adults. Median within-population interquartile ranges were 74,000 copies/mL for RNA with no significant change during the course of infection; and 330 cells/microL for CD4, with a slight proportional increase over infection. Applying measurement and physiological fluctuations observed on chronically infected patients, we estimate that 45% of population-level variation in RNA, and 25% of variation in CD4, were due to within-patient fluctuations. Comparing a patient with RNA at upper 75(th) centile with a patient at median RNA, 5-year relative risks were 1.4 (95% CI 1.2-1.7) for AIDS and 1.5 (1.3-1.9) for death, without change over the course of infection. In contrast, for a patient with CD4 count at the lower 75(th) centile, relative risks increased from 1.0 at seroconversion to maxima of 6.3 (4.4-8.9) for AIDS and 5.5 (2.7-10.1) for death by year 6, when the population median had fallen to 300 cells/microL. Below 300 cells/microL, prognostic power did not increase, due to a narrower CD4 range.
conclusionsFindings support the current WHO recommendation (used with clinical criteria) to start antiretroviral treatment in low-income settings at CD4 thresholds of 200-350 cells/microL, without pre-treatment RNA monitoring--while not precluding earlier treatment based on clinical, socio-demographic or public health criteria.
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