Correlation of ribonucleic acid polymerase chain reaction, acid dissociated p24 antigen, and neopterin with progression of disease: A retrospective, longitudinal study of vertically acquired human immunodeficiency virus type 1 infection in children

Objective: We investigated the relationship between cell-free viral load, neopterin, age-adjusted CD4 ⁺ cell concentration, and clinical events in 49 children with vertically acquired human immunodeficiency virus type 1 infection.Study design: Viral load was measured by quantitating viral ribonucleic acid in serum by polymerase chain reaction and measurement of immune complex dissociated p24 antigen in serum and plasma. Children were followed for an average of 2½ years, with an average of 6 samples per child. Medical records were reviewed for weight, CD4 ⁺ cell count, and clinical events.Results: High virus copy number in serum was predictive of a decrease in weight-for-agezscore during the subsequent 6 months. High viral load, low CD4 ⁺ cell count, and high neopterin level were correlated with encephalopathy. High viral load correlated with opportunistic infections. All of these relationships held regardless of treatment status, although viral load decreased significantly after treatment was begun.Conclusions: Measurements of viral load were useful prognostic indicators for poor weight gain. Elevated serum virus levels and neopterin values and low CD4 ⁺ cell counts were all associated with encephalopathy. (J Pediatr 1997:130:898-905)