title: Natural history of serum HIV-1 RNA levels in 330 patients with a known date of infection. The SEROCO Study Group.
abstract: 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.
authors.affiliation: Department of Epidemiology, INSERM U292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
authors.forename: J B
authors.initials: JB
authors.lastname: Hubert
authors.forename: M
authors.initials: M
authors.lastname: Burgard
authors.forename: E
authors.initials: E
authors.lastname: Dussaix
authors.forename: C
authors.initials: C
authors.lastname: Tamalet
authors.forename: C
authors.initials: C
authors.lastname: Deveau
authors.forename: J
authors.initials: J
authors.lastname: Le Chenadec
authors.forename: M L
authors.initials: ML
authors.lastname: Chaix
authors.forename: E
authors.initials: E
authors.lastname: Marchadier
authors.forename: J L
authors.initials: JL
authors.lastname: Vildé
authors.forename: J F
authors.initials: JF
authors.lastname: Delfraissy
authors.forename: L
authors.initials: L
authors.lastname: Meyer
authors.lastname: Rouzioux
mesh_terms: 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
chemical_list: D012367:RNA, Viral; D011933:Reagent Kits, Diagnostic