Impact of baseline viral load and adherence on survival of HIV-infected adults with baseline CD4 cell counts ≥ 200 cells/μl

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Abstract
Background: Baseline plasma HIV RNA levels > 100 000 copies/ml have been associated with elevated mortality rates after the initiation of HAART. There is uncertainty regarding the optimal strategy for patients with high plasma HIV RNA but CD4 cell count ≥ 200 cells/μl. Objective: To evaluate the impact of baseline plasma HIV RNA on survival among patients with CD4 cell counts ≥ 200 cells/μl. Methods: Patients were stratified by plasma HIV RNA, CD4 cell count and adherence level. Mortality rates were evaluated using Kaplan–Meier methods and Cox regression. Results: Among 1166 patients initiating HAART with a CD4 cell count ≥ 200 cells/μl, a baseline HIV RNA ≥ 100 000 copies/ml was statistically associated with elevated mortality among non-adherent patients (log-rank P = 0.032), but not for adherent patients (log-rank P = 0.690). In a multivariate Cox model comparing patients with a baseline CD4 cell count ≥ 200 cells/μl and a baseline plasma HIV RNA < 100 000 copies/ml, the mortality rate was statistically similar among patients with a baseline CD4 cell count ≥ 200 cells/μl and a baseline plasma HIV RNA ≥ 100 000 copies/ml (relative hazard, 1.21; 95% confidence interval, 0.89–1.65; P = 0.232). Conclusion: HIV RNA ≥ 100 000 copies/ml was only associated with mortality among HIV-infected patients initiating HAART with CD4 cell counts ≥ 200 cells/μl if the patients were non-adherent.