Quantitation of HIV-1 RNA in plasma predicts outcome after seroconversion.
OBJECTIVE
To investigate the relation between the quantity of human immunodeficiency virus type 1 (HIV-1) RNA in plasma and the risk for the acquired immunodeficiency syndrome (AIDS) or a decline in the CD4+ T-cell count after seroconversion.


METHODS
Prospective study.


METHODS
62 homosexual men with documented HIV-1 seroconversion.


METHODS
University outpatient setting.


METHODS
Clinical status, CD4+ T-cell counts, and plasma and serum samples were obtained every 6 months. Human immunodeficiency virus RNA in plasma was quantitated with a branched-DNA (bDNA) assay. Serum samples were assayed for neopterin, beta 2-microglobulin, and immune complex dissociated HIV-1 p24 antigen.


RESULTS
18 of 62 (29%) men developed AIDS; 21 (34%) had a significant decline in the CD4+ T-cell count without AIDS; and 23 (37%) had a stable CD4+ T-cell count. For each participant, HIV-1 RNA results were categorized into one of four groups: 1) detection of HIV-1 RNA (> 1 x 10(4) genome equivalents/mL [Eq/mL]) in all samples; 2) detection in most samples (> or = 50%); 3) detection in fewer than 50% of samples; and 4) detection in none of the samples. Detection of HIV-1 RNA in all or most samples was strongly associated with AIDS (16 of 18 patients) and a decline in the CD4+ T-cell count (13 of 21 patients) compared with a stable CD4+ T-cell count (4 of 23 patients; P < 0.001). Conversely, the absence of HIV-1 RNA (< 1 x 10(4) Eq/mL) in all or most samples was associated with stable CD4+ T-cell counts (19 of 23 patients) and a lower risk for AIDS or decline in the CD4+ T-cell count (10 of 39 patients; P < 0.001). In multivariate analysis of all laboratory values at the seroconversion visit, a plasma HIV-1 RNA level greater than 1 x 10(5) Eq/mL was the most powerful predictor of AIDS (odds ratio, 10.8; P = 0.01).


CONCLUSIONS
Plasma HIV-1 RNA is a strong, CD4+ T-cell-independent predictor of a rapid progression to AIDS after HIV-1 seroconversion.
Mellors
J W
JW
University of Pittsburgh, Pennsylvania.
Kingsley
L A
LA
Rinaldo
C R
CR
Todd
J A
JA
Hoo
B S
BS
Kokka
R P
RP
Gupta
P
P
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000821:virology; D001708:Biopterins / Q000031:analogs & derivatives / Q000097:blood; D018791:CD4 Lymphocyte Count; D016655:HIV Core Protein p24 / Q000097:blood; D006679:HIV Seropositivity / Q000097:blood / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D019798:Neopterin; D010865:Pilot Projects; D016133:Polymerase Chain Reaction; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D012307:Risk Factors; D001613:beta 2-Microglobulin / Q000378:metabolism
D016655:HIV Core Protein p24; D012367:RNA, Viral; D001613:beta 2-Microglobulin; D001708:Biopterins; D019798:Neopterin