Natural history of HIV-1 cell-free viremia.
OBJECTIVE
To characterize the natural history of viremia with human immunodeficiency virus type 1 (HIV-1) and its association with disease progression from infection to acquired immunodeficiency syndrome (AIDS).


METHODS
Prospective cohort study. Annual specimens were tested for quantitative virion-associated HIV-1 RNA, p24 antigen, and CD4+ lymphocyte levels.


METHODS
A total of 42 homosexual men who seroconverted to HIV-1 between 1982 and 1985.


METHODS
Trends over time in serum HIV-1 RNA level, correlations between serum HIV-1 RNA and other markers, and prediction of AIDS using these markers.


RESULTS
HIV-1 RNA levels were stable over time, increasing by 10-fold or more in only six (14%) of the 42 subjects during 3 to 11 years of follow-up. Mean HIV-1 RNA levels were 10(3.8) copies/mL if AIDS occurred in less than 4 years, 10(3.07) copies/mL if AIDS developed within 4 through 9 years, and 10(2.27) copies/mL if AIDS did not develop within 6 through 11 years. In both univariate and multivariate models, initial and subsequent HIV-1 RNA levels, p24 antigenemia, and percentage of CD4+ lymphocytes were independently predictive of AIDS.


CONCLUSIONS
The stability of virion-associated HIV-1 RNA levels suggests that an equilibrium between HIV-1 replication rate and efficacy of immunologic response is established shortly after infection and persists throughout the asymptomatic period of the disease. Thus, defective immunologic control of HIV-1 infection may be as important as the viral replication rate for determining AIDS-free survival. Because individual steady-state levels of viremia were established soon after infection, HIV-1 RNA levels may be useful markers for predicting clinical outcome.
Henrard
D R
DR
Department of Medical Research, Abbott Laboratories, North Chicago, Ill., USA.
Phillips
J F
JF
Muenz
L R
LR
Blattner
W A
WA
Wiesner
D
D
Eyster
M E
ME
Goedert
J J
JJ
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood* / Q000276:immunology / Q000401:mortality; D000328:Adult; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005434:Flow Cytometry; D016655:HIV Core Protein p24 / Q000032:analysis / Q000097:blood*; D015658:HIV Infections / Q000097:blood / Q000503:physiopathology*; D015497:HIV-1 / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis / Q000097:blood*; D016019:Survival Analysis; D014766:Viremia / Q000097:blood / Q000503:physiopathology*; D014779:Virus Replication
D015415:Biomarkers; D016655:HIV Core Protein p24; D012367:RNA, Viral