Early and late HIV-1 RNA level and its association with other markers and disease progression in long-term AIDS-free homosexual men.
OBJECTIVE
To study the association between virological markers and clinical progression in individuals with long-term AIDS-free HIV infection.


METHODS
Seventy-seven HIV-infected participants in the Amsterdam cohort study who remained AIDS-free for at least 8 years were prospectively followed during that time and during a subsequent period in which 15 developed AIDS.


METHODS
Serum HIV-1 RNA levels were evaluated at 1 and 8 years after study entry. Progression to AIDS following the 8 AIDS-free years was studied using Kaplan-Meier estimates and Cox proportional hazard analysis.


RESULTS
HIV-1 RNA increased over time in a large proportion of these long-term AIDS-free men. Most subjects showed progressive immune system damage and/or clinical manifestations of HIV disease at year 8. High RNA levels at year 8 were significantly associated with symptomatic HIV Infection, low CD4+ T-cell count, p24 antigenaemia, low T-cell reactivity at year 8 as well as rapid annual CD4+ T-cell decline. High RNA level at year 1 was associated with high RNA levels at year 8 and low CD4+ T-cell count at year 1. In univariate analysis, RNA was associated with progression to AIDS after 8 years. In multivariate analysis, only the CD4+ T-cell count at year 8 remained significantly associated with progression to AIDS.


CONCLUSIONS
In later stages of HIV infection, measures of immune deficiency may be more powerful prognostic markers than serum HIV-1 RNA level, indicating that optimal staging of the HIV-infected patient requires the combined use of RNA levels, CD4+ T-cell counts, and T-cell reactivity instead of RNA levels alone.
Spijkerman
I J
IJ
Division of Public Health and Environment, University of Amsterdam, The Netherlands.
Prins
M
M
Goudsmit
J
J
Veugelers
P J
PJ
Coutinho
R A
RA
Miedema
F
F
de Wolf
F
F
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D000328:Adult; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D018450:Disease Progression; D016655:HIV Core Protein p24 / Q000032:analysis; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology* / Q000821:virology*; D006679:HIV Seropositivity; D015497:HIV-1 / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis* / Q000097:blood; D017741:Survivors; D013601:T-Lymphocytes / Q000276:immunology
D015415:Biomarkers; D016655:HIV Core Protein p24; D012367:RNA, Viral