title: Prognostic value of serum HIV-RNA levels at virologic steady state after seroconversion: relation to CD4 cell count and clinical course of primary infection.
abstract: The objectives of this study were to evaluate the prognostic value of a single serum HIV-RNA measurement 6-24 months after HIV seroconversion, and to investigate whether any differences in outcome related to the clinical course of primary infection could be explained by presumed steady-state HIV-RNA levels at 6-24 months after seroconversion. Disease progression was analyzed by life tables and Cox proportional hazard models. A total of 93 HIV seroconverters followed for a median of 76 months (range, 19-143 months) were included in the study. The main outcome measures were development of AIDS stratified by age, the year of seroconversion, serum HIV-RNA levels, CD4 cell counts, and duration of primary illness. The proportion of patients who developed AIDS was 36% (95% confidence interval, 22%-50%) at 8 years and 50% (26%-75%) at 10 years. In the unadjusted analyses, clinical progression was significantly associated with serum HIV-RNA levels, CD4 cell counts, and duration of primary illness. The adjusted analyses indicated that HIV-RNA was the strongest predictor. Patients with long-lasting symptoms associated with primary infection had significantly higher serum HIV-RNA levels than those with less severe presentations (median counts, 11,660 vs. 2880 copies/ml, p = 0.001). It is concluded that the serum HIV-RNA level in early HIV infection is a strong independent predictor of clinical progression. Patients with long-lasting primary illnesses reach a higher viral load in steady state after seroconversion, which is probably the main reason for the poorer prognosis observed in this group of patients.
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Pedersen
authors.forename: T
authors.initials: T
authors.lastname: Katzenstein
authors.forename: C
authors.initials: C
authors.lastname: Nielsen
authors.forename: J D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: J
authors.initials: J
authors.lastname: Gerstoft
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology; D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D006678:HIV / Q000235:genetics*; D015658:HIV Infections / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology; D006679:HIV Seropositivity; D006801:Humans; D008137:Longitudinal Studies; D011237:Predictive Value of Tests; D011379:Prognosis; D012367:RNA, Viral / Q000032:analysis* / Q000097:blood; D012720:Severity of Illness Index; D013997:Time Factors; D019562:Viral Load
chemical_list: D012367:RNA, Viral