Korenromp EL, Williams BG, Schmid GP, Dye C (2009) Clinical Prognostic Value of RNA Viral Load and CD4 Cell Counts during Untreated HIV-1 Infection—A Quantitative Review. PLoS ONE 4(6): e5950. doi:10.1371/journal.pone.0005950 [1]
The purpose of the study was to determine if the current World Health Organisation criteria for commencing HAART are appropriate. The study abstract concludes:
Findings support the current WHO recommendation (used with clinical criteria) to start antiretroviral treatment in low-income settings at CD4 thresholds of 200–350 cells/µL, without pre-treatment RNA monitoring – while not precluding earlier treatment based on clinical, socio-demographic or public health criteria.
Interestingly, the authors found:
Mean relative risks per 10-fold higher RNA were 2.0 (95% confidence interval (CI): 1.8–2.5) for AIDS (12 studies, 17 datapoints) and 2.5 (2.1–3.0) for death (9 studies, 10 datapoints). These prognostic risks did not vary over time after seroconversion, or with duration of follow-up, geographical region, baseline CD4, use of antiretroviral mono-/bi-therapy, or average clinical progression rates.
They also found:
In contrast, relative risks per 100 cells/µL lower CD4 increased with time after seroconversion, for both AIDS (10 studies, 14 datapoints) and death (7 studies, 8 datapoints): from 1.0 at seroconversion to an estimated 3.0 (95% CI 2.6–3.4) by 6 years for AIDS (p<0.0001 for trend), and to 2.8 (1.9–3.7) for death (p<0.0001). In multivariate regression, this pattern was not modified by duration of follow-up, geographical region, baseline CD4, use of antiretroviral mono-/bi-therapy or average progression rates.
In other words, viral load and CD4 count predict death. Coupled with the immense evidence that HAART reduces viral load and increases CD4 counts, these findings are, of course, incompatible with AIDS denialist theories.
Links:
[1] http://www.plosone.org/article/info:doi/10.1371/journal.pone.0005950