Predictors of disease progression in HIV-infected homosexual men with CD4+ cells < 200 x 10(6)/l but free of AIDS-defining clinical disease.
OBJECTIVE
To study progression of HIV infection in individuals who are free of AIDS-defining clinical disease with CD4+ cell counts < 200 x 10(6)/l.


METHODS
Prospective and nested case-control study.


METHODS
Amsterdam cohort study on HIV infection, The Netherlands.


METHODS
Prospective study: 148 asymptomatic HIV-infected individuals with < 200 x 10(6)/l CD4+ cells. Nested case-control study: 58 men with AIDS-free follow-up more than 2 years after CD4 count < 200 x 10(6)/l, compared with 63 who progressed to AIDS within 2 years.


METHODS
Progression to AIDS according to the 1987 Centers for Disease Control and Prevention case definition and death.


RESULTS
Median AIDS-free interval was 22 months, median interval to death 41 months. Presence of syncytium-inducing (SI) HIV variants, HIV p24 antigen, and a low T-cell response after stimulation with phytohaemagglutinin (PHA) were independent predictors of progression to AIDS. Probability of 1 year AIDS-free survival varied between 89 and 38% by the presence or absence of these additional markers. Effect of early treatment could only be detected in men with HIV p24 antigen and SI variants. Case-control analysis showed similar changes over time regarding prognostic markers in both groups although at a lower rate in the AIDS-free men. Eight men remained AIDS-free more than 4 years, SI variants were absent in seven, and all eight were p24-seronegative.


CONCLUSIONS
HIV-infected individuals can remain disease-free for more than 4 years with very low CD4+ cell counts, provided that they lack other progression markers: SI variants, p24 antigen and a low PHA-induced T-cell reactivity. A beneficiary effect of early treatment may be limited to men with SI variants and/or p24 antigen.
Municipal Health Service, Department of Public Health and Environment, Amsterdam, The Netherlands.
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IP
Keet
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Krol
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Koot
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Roos
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de Wolf
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Miedema
R A
RA
Coutinho
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology* / Q000503:physiopathology; D000704:Analysis of Variance; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005500:Follow-Up Studies; D016655:HIV Core Protein p24 / Q000097:blood; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality / Q000503:physiopathology; D006679:HIV Seropositivity / Q000276:immunology* / Q000401:mortality / Q000503:physiopathology; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D008213:Lymphocyte Activation; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors
D016655:HIV Core Protein p24