Document Preview
  • Full Text
  • Scholarly Journal

Prognosis in HIV-1 infection predicted by the quantity of virus in plasma

Full text preview

The prognosis of individuals infected with HIV-1 is variable. In adults, the average time between infection and development of AIDS is 10 to 11 years (1), but a significant proportion of individuals (==20%) progresses rapidly to AIDS within 5 years of infection (2). At the other extreme, it is estimated that 12% of infected individuals will remain free of AIDS for 20 years (2).

Many clinical and laboratory markers have been used to estimate prognosis in HIV-1 infection (3). Although the single best predictor of AIDS onset characterized to date is the percentage or absolute number of circulating CD4+ T cells (4), a marker that could be used to assess risk before substantial immune destruction has occurred would be preferable. Recent interest has focused on measurement of HIV-1 RNA in cells or plasma for prediction of outcome (5, 6). Previous studies have suggested that the amount of HIV-1 RNA in plasma soon after HIV-1 infection (seroconversion) is a good CD4+ T cell-independent predictor of AIDS risk (7). In clinical settings, however, the date and duration of HIV-1 infection are usually not known. We have now investigated the prognostic value of plasma HIV-1 RNA measurements in a large cohort of HIV-1 infected men for whom the duration of infection at study entry was not known.

The study population consisted of 209 HIV-1-infected gay or bisexual men enrolled in the Pittsburgh portion of the Multicenter AIDS Cohort Study (MACS) between April 1984 and March 1985 (8, 9). These 209 men constitute all of the HIV--seropositive men enrolled at the Pittsburgh site; thus, there was no selection bias in choosing the study population. Clinical status, CD4+ T cell counts (10, 11), and specimens for laboratory studies were obtained at study entry (baseline) and at follow-up visits every 6 months. Heparinized plasma samples for HIV-1...