Serum HIV-1 RNA levels and time to development of AIDS in the Multicenter Hemophilia Cohort Study.
OBJECTIVE
To determine if the long-term incidence of the acquired immunodeficiency syndrome (AIDS) is related to human immunodeficiency virus type 1 (HIV-1) RNA levels measured early in HIV-1 infection.


METHODS
Epidemiologic cohort study.


METHODS
Five hemophilia treatment centers in the United States.


METHODS
A total of 165 subjects with hemophilia and HIV-1 infection (age at HIV-1 seroconversion, 1-66 years) followed from 1979 to 1995.


METHODS
The HIV-1 RNA level was measured by polymerase chain reaction over a range of 200 to 1 million or more HIV-1 RNA copies/mL in archived serum specimens collected 12 to 36 months (median, 27 months) after the estimated date of HIV-1 seroconversion. Kaplan-Meier methods were used to examine the risk of AIDS and proportional hazards models were used to estimate relative hazards.


RESULTS
The HIV-1 RNA values were similar in subjects younger than 17 years at seroconversion (median, 5214 copies/mL) and those 18 to 34 years old (median, 4693 copies/mL), but higher in those 35 years or older (median, 12069 copies/mL) (P = .02 compared with each younger group). At 10 years after seroconversion, the proportions of subjects with AIDS were 72% among subjects with 100,000 or more HIV-1 RNA copies/mL measured 12 to 36 months after HIV-1 seroconversion (n = 9), 52% among subjects with 10,000 to 99,999 copies/mL (n = 55), 22% among subjects with 1000 to 9,999 copies/mL (n = 82), and 0% among subjects with fewer than 1000 copies/mL (n = 19) (P < .001). The age-adjusted relative hazard for AIDS for subjects with 10,000 or more copies/mL was 14.3 (95% confidence interval, 1.9-105.6) compared with subjects with fewer than 1000 copies/mL.


CONCLUSIONS
The HIV-1 RNA level during early chronic HIV-1 infection is a strong, age-independent predictor of clinical outcome; low levels define persons with a high probability of long-term AIDS-free survival.
O'Brien
T R
TR
Viral Epidemiology Branch, National Cancer Institute, Rockville, MD 20852, USA.
Blattner
W A
WA
Waters
D
D
Eyster
E
E
Hilgartner
M W
MW
Cohen
A R
AR
Luban
N
N
Hatzakis
A
A
Aledort
L M
LM
Rosenberg
P S
PS
Miley
W J
WJ
Kroner
B L
BL
Goedert
J J
JJ
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D006679:HIV Seropositivity / Q000097:blood* / Q000150:complications / Q000401:mortality; D015497:HIV-1 / Q000235:genetics*; D006467:Hemophilia A / Q000150:complications; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000097:blood*; D016019:Survival Analysis; D013997:Time Factors
D012367:RNA, Viral