Claudia A. Kozinetz, PhD, MPH¹, Rodica Matusa, MD², Simona Ruta, PhD³, Costin Cernescu, MD, PhD³, Carl Hacker, PhD, JD⁴, and Andreea Cazacu, MD⁵. (1) Epidemiology Center, Department of Pediatrics, Baylor College of Medicine, 6221 Fannin, FC245, Houston, TX 77030, 832-824-3730, kozinetz@bcm.tmc.edu, (2) Speranta Association, Str. Prelungirea Liliacului Nr. 10, KM. 4-5, Constanta, Romania, (3) Virology, Stefan S. Nicolau Institute of Virology, 285 sos. Mihai Bravu, Bucharest, Romania, (4) Division of Management, Policy and Community Health, School of Public Health University of Texas Health Science Center at Houston, 1200 Herman Pressler, Houston, TX 77030, (5) Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030

BACKGROUND: Monitoring HIV disease progression in the developing world remains a challenge. Tests used in developed countries, HIV-RNA and CD4 count, are too complex for most laboratories and too expensive for the health care system and patients in developing countries. The objective of this study was to investigate the prognostic ability of immune complex-dissociated (ICD) p24 antigen. METHODS: We used a cohort of 161 horizontally-infected HIV-positive adolescents in Constanta, Romania. Standard clinical data were collected at baseline and one-year followup. Serum was obtained at baseline for viral load and ICD p24 antigen determinations. The dichotomous outcome variable defining disease progression was >55,000 copies/ml of HIV RNA at followup or death. Logistic regression analysis was used to estimate the prognostic ability of ICD p24 antigen. RESULTS: At baseline, the study population was 53% male, had a mean age of 13.9 (standard deviation=1.2) and 69% were receiving antiretrovirals. ICD p24 antigen at baseline ranged from <19.5 to 1,000 pg/ml. Univariate logistic regression analyses showed that detectable ICD p24 antigen resulted in an odds ratio of 3.7 (95% confidence interval (CI) 1.4-9.3) for disease progression in comparison to an undetectable ICD p24 antigen. ICD p24 antigen remained a significant predictor of disease progression with an odds ratio of 3.7 (95%CI 1.4-9.7) after adjustment for gender, age and baseline antiretrovirals. CONCLUSION: Using ICD p24 antigen to identify adolescents at high risk of disease progression could be a viable alternative to the more expensive and technically difficult HIV-RNA and CD4 assays in developing countries.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Recognize the need for alternative laboratory methods for monitoring HIV-disease progression in developing countries.
• Evaluate the use of ICD p24 antigen for HIV-disease progression.

Keywords: HIV/AIDS, Disease Management

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.