p24 as a predictor of mortality in a cohort of HIV-1-infected adults in rural Africa

J Acquir Immune Defic Syndr. 2008 Jul 1;48(3):345-9. doi: 10.1097/QAI.0b013e31817dc3d1.

Abstract

Background: Implementation of antiretroviral treatment in sub-Saharan Africa requires efficient tools to monitor HIV patients. p24 measurements have been proposed as an alternative to HIV-RNA because of the low cost of reagents and equipment needed. Here, we evaluate p24 as a prognostic marker in a cohort of HIV-1-infected individuals in Zimbabwe.

Methods: Treatment-naive HIV-1-infected individuals (n=198) from the Mupfure Schistosomiasis and HIV Cohort were followed until death or censoring (3-4.3 years). At baseline, p24, HIV-RNA, CD4 cell counts, and clinical staging (Centers for Disease Control and Prevention classification) were assessed.

Results: p24 correlated with HIV-RNA (P<0.0001, R: 0.44). Ten percent of p24 but only 1% of HIV-RNA measurements was undetectable. p24 predicted Centers for Disease Control and Prevention category (P<0.001) stronger than CD4 count (P=0.34) in multivariate logistic regression. p24 predicted mortality in univariate Cox analysis (P<0.0001) and in multivariate analysis, but it was inferior to HIV-RNA and CD4 count.

Conclusions: This is the first study to evaluate the prognostic strength of p24 in an area with a predominance of HIV subtype C infections. p24 correlated with HIV-RNA and predicted clinical stage better than CD4 count. It predicted mortality in both univariate and multivariate analysis, but in multivariate analysis, it was inferior to HIV-RNA and CD4 count.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome
  • Adult
  • Biomarkers / analysis
  • CD4 Lymphocyte Count
  • HIV Core Protein p24 / analysis*
  • HIV Infections / mortality*
  • HIV-1 / genetics
  • HIV-1 / metabolism*
  • Humans
  • Predictive Value of Tests
  • Prognosis
  • RNA, Viral
  • Survival Analysis
  • Zimbabwe

Substances

  • Biomarkers
  • HIV Core Protein p24
  • RNA, Viral