Abstract

RUBIO CABALLERO, M. et al. Survival and progression in 251 patients with HIV-1 disease: Study of  p24 antigen and viral load as surrogate markers. Their utility in 4 years of follow-up . An. Med. Interna (Madrid) [online]. 2001, vol.18, n.10, pp.25-28. ISSN 0212-7199.

Background: Prospective study of survival and AIDS or death progression in a cohort of 251 HIV infected patients whose seroconversion time is unknown , with a main objetive: To analyse p24 antigen plasmatic levels and viral load as surrogate markers. Patients: 251 patients were included, most of them undergoing anti -retroviral therapy, and were followed-up consecutively in the HIV/AIDS Unity of Internal Medicine Service of the Hospital Universitario Arnau de Vilanova in Lleida. Methods: We made clinical and analytical baseline studies and every 3 months thereafter. Related to p24 antigen 3 group were established: group 1, < 20 pg/mL, group 2, 20-39 pg/mL, group 3, 40 or more pg/mL.  We studied survival and progression according to baseline levels over 4 year period. Regard to viral load, we just compared this with p24 antigen in the last phase of the study (third and fourth year) for technical reasons. Survival analysis was made by Kaplan-Meier estimation. Relative risk was calculated by Cox’s proportional hazards model. Results: During the 48 months of follow-up 55 patients died. AIDS progression risk or death was 4.8 times higher for the p24 antigen = 40 pg/mL group than for the p24 antigen < 20 pg/mL one; the relative risk of patients with p24 antigen between 20-39 pg/mL was 2.5 times hig -her than those included in the group of p24 antigen < 20 pg/mL. Related to progression study, 34 patients progressed. AIDS progres -sion risk or death for p24 antigen = 40 pg/mL group was 7.69 times higher compared with group 2 (p24 antigen levels between 20-39 pg/mL). The comparison with viral load by PCR determination shows contro -versial results. Conclusions: p24 antigen plasma level is a good survival and AIDS progress or death surrogate markers in HIV infected patients, and it is useful for 4 years or more. An isolated value < 20 pg/mL is a sign of good prognosis. Parallelism between p24 antigen plasmatic level and viral load has not been observed.

Keywords : AIDS; Prognosis; Survival; Surrogate markers; p24 anti -gen.

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