Objective: To correlate the plasma HIV RNA in HIV infected children with clinical category and CD4 cell counts.

Methods: Blood was collected from a 120 HIV infected children in sterile tubes using ACD as the anticoagulant. Plasma was separated from whole blood within 6 hours of collection. The AMPLICOR HIV-1 MONITOR Test by Roche was used for the quantitation of HIV-1 RNA. Results were correlated with CDC clinical classification at the time of testing. Lymphocyte subsets were obtained at approximately the same time and HIV RNA were correlated with absolute CD4 cells and percent.

Results: 120 children were studied of which 118 were perinatally infected and 2 by transfusion. The median age of the group was 6 years (range 5 months to 16 years). All but 20 children were receiving antiretroviral therapy. When grouped by CDC Classification, the number of children and media age group per clinical category were N (8) 5 years, A (23) 5 years, B (56) 5 years and C (33) 3years. The median RNA HIV copies/mL plasma per category was N 33,000 (0-157,000), A 37,750 (400-567,000), B 35,000 (0-750.000) and C 315,000 (6600-1,454,560). The strength of association (r) between progression of clinical category and HIV RNA levels was 0.42 with a p value of 0. The HIV RNA levels were inversely proportional to both absolute CD4 cells (r = -0.12, p = 0.170) and% CD4 (r = -0.3) but the correlation was significant only for the% CD4 (p = 0.0008).

Conclusions: HIV RNA plasma level vary widely on infected children in all stages of disease, but the highest levels occured in clinical category C. HIV RNA levels demonstrate a significant negative correlation with the CD4% and not with the absolute CD4 cell number. HIV RNA levels in HIV infected children appear to be a more sensitive prognostic indicator for HIVdisease progression than any other clinical or immunological parameter.