Longitudinal HIV-1 RNA levels in a cohort of homosexual men.
HIV-1 RNA levels measured during early chronic infection strongly predict subsequent clinical events. In the short term, HIV-1 is in a steady state, but the stability of viral levels over time is incompletely understood. We used reverse transcriptase polymerase chain reaction (RT-PCR) to examine changes in serum HIV-1 RNA levels in 111 HIV-1-infected homosexual men during the period from 1982 to 1992 and their relation to clinical outcomes. HIV-1 RNA levels increased by a median of 0.08 log10 copies/ml/year (p=.0001). HIV-1 RNA levels rose either gradually or abruptly for the majority of subjects; 41% had no increase. Among subjects surviving at least 8 years, HIV-1 RNA was stable during the first 4 years after seroconversion (median. 0.00 log10 copies/ml/year), but rose in years five through eight (median, 0.06 log10 copies/ml/year; p=.04). The annual HIV-I RNA level was more predictive of AIDS (relative hazard [RH], 1.75 per 0.5 log difference; 95% confidence interval [CI], 1.38-2.21; likelihood ratio [LR], 26.2) than the initial level alone (RH, 1.39; 95% CI. 1.10-1.76; LR, 8.5). We conclude that most HIV-1-infected persons lack a long-term viral setpoint and that failure to account for evolution of the viral level can lead to underestimation of the risk of progression.
O'Brien
T R
TR
Viral Epidemiology Branch, National Cancer Institute, Public Health Service, U.S. Department of Health and Human Services, Rockville, Maryland 20852, USA.
Rosenberg
P S
PS
Yellin
F
F
Goedert
J J
JJ
D000328:Adult; D015331:Cohort Studies; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D006679:HIV Seropositivity / Q000097:blood / Q000821:virology; D015497:HIV-1 / Q000235:genetics*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000097:blood*; D012194:RNA-Directed DNA Polymerase; D014766:Viremia / Q000821:virology
D012367:RNA, Viral; D012194:RNA-Directed DNA Polymerase