Natural history of serum HIV-1 RNA levels in 330 patients with a known date of infection. The SEROCO Study Group.
OBJECTIVE
To describe the spontaneous course, before the introduction of highly active antiretroviral therapy (HAART), of HIV-1 RNA during the AIDS-free period of the disease. To assess the predictive value of changes in HIV-1 RNA levels.


METHODS
A total of 330 patients with a known date of infection followed in the SEROCO cohort.


METHODS
HIV-1 RNA levels (threshold, 200 copies/ml) were evaluated from 2243 frozen sera obtained from enrolment until the onset of AIDS or until February 1996. Lowess curves were used to describe the variations of viraemia during follow-up. A Cox regression model was used to assess the predictive value of early and updated CD4 cell count and viral load.


RESULTS
In addition to a lower early viral load, patients who remained AIDS-free had, on average, a longer period of viral load decrease after infection (36 versus 18 months), followed by a slower viral load increase compared with those who progressed to AIDS. A true plateau-phase after the seroconversion period, lasting approximately 4 years, was identified only in patients who remained AIDS-free for at least 90 months. In multivariate analysis, both early viral load and later changes were significant predictors of progression to AIDS. A decrease in the CD4 cell count to less than 200 cells/microl and the onset of a group B condition remained significant predictors of progression.


CONCLUSIONS
Our study extends to the early post-seroconversion phase the prognostic value of extracellular HIV-1 RNA levels. Moreover, our data suggest that, in most HIV-infected individuals, a progressive loss of control of viral replication arises during the early years of HIV-1 infection.
Hubert
J B
JB
Department of Epidemiology, INSERM U292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Burgard
M
M
Dussaix
E
E
Tamalet
C
C
Deveau
C
C
Le Chenadec
J
J
Chaix
M L
ML
Marchadier
E
E
Vildé
J L
JL
Delfraissy
J F
JF
Meyer
L
L
Rouzioux
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology / Q000821:virology; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000276:immunology / Q000473:pathology / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000032:analysis; D011933:Reagent Kits, Diagnostic; D015819:Substance Abuse, Intravenous / Q000821:virology; D013997:Time Factors; D065227:Transfusion Reaction; D019562:Viral Load
D012367:RNA, Viral; D011933:Reagent Kits, Diagnostic