[AIDS; new developments. III. Predictive value of the quantity of HIV-RNA for the course of the HIV infection and the effect of the treatment].
Standardized tests to measure the quantity of HIV-RNA in blood have been available since early 1995. Individual differences in quantity of HIV-RNA in blood are determined mainly by differences in virus production. Most of the HIV production takes place in infected and activated CD4+ T lymphocytes. The concentration of HIV-RNA in plasma or serum is an important predictor of AIDS and death, in the early stage of the infection even the only one. High concentrations (> or = 10(4) HIV-RNA copies/ml) in the early stage of the infection increase the probability of AIDS from 2.5 to 5 times that with concentrations < 10(4) HIV-RNA copies/ml. The degree of reduction of the HIV-RNA concentration during anti-HIV therapy is of great predictive value for the clinical course. The percentage of persons in whom the amount of HIV-RNA decreases to below the limit of detectability is a good second indicator of a favourable prognosis. Consequently, anti-HIV treatment should be started as early as possible in the infection, and not postponed until the first symptoms of immunodeficiency occur; only then can the virus production be kept at a minimal level as early and as long as possible. The current guideline reads: determination of HIV-RNA concentrations in serum or plasma should be part of the standard clinical practice in monitoring HIV-infected persons. Treatment is started as soon as occasioned by the quantity of HIV-RNA (limit: 10,000 copies/ml), the CD4+ cell count (limit: 500 x 10(6)/l) or the onset of HIV-related symptoms. The quantity of HIV-RNA should diminish substantially during the first three months of treatment. If this is the case, one checkup every three months will suffice. If the HIV-RNA concentration does not decrease sufficiently, resistance or poor compliance may be involved.
de Wolf
F
F
Academisch Medisch Centrum, afd. Humane Retrovirologie, Amsterdam.
Goudsmit
J
J
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000821:virology; D015496:CD4-Positive T-Lymphocytes / Q000821:virology; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D012367:RNA, Viral / Q000097:blood*; D013997:Time Factors
D012367:RNA, Viral