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p24 as a Predictor of Mortality in a Cohort of HIV-1-Infected Adults in Rural Africa

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, R2: 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.