Spontaneous control of viral load and CD4 cell count progression among HIV-1 seroconverters.
OBJECTIVE
To identify factors associated with sustained undetectable viraemia after HIV-1 seroconversion in treatment-naive patients, and to describe concomitant CD4 cell count progression.


METHODS
Seroconverters enrolled in CASCADE were assumed to control viraemia if at least two consecutive viral load measurements were < 400/500 copies/ml without treatment. Factors associated with undetectable viraemia were identified through a logistic regression. A joint model was used to describe simultaneously the CD4 cell count progression during and after that period and to identify factors associated with sustained undetectable viraemia.


RESULTS
Of 2176 seroconverters, 145 (6.7%) spontaneously controlled viraemia. Women were more likely than men to achieve undetectable viraemia [adjusted odds ratio (OR), 2.12; 95% confidence interval (CI), 1.49-3.12] unlike patients who reported a symptomatic primary infection (adjusted OR, 0.58; 95% CI, 0.36-0.94). AIDS and death rates were significantly lower in patients achieving undetectable viraemia than in the others. The median period of undetectable viraemia was 11.2 months; on average, CD4 cell counts remained stable during that period, and decreased with a mean rate of 5 cells/microl per month thereafter. High CD4 cell count at the beginning of undetectable viraemia and non-symptomatic primary infection favoured the preservation of undetectable viraemia.


CONCLUSIONS
A small proportion of seroconverters appeared to be able to control HIV viraemia spontaneously, mostly those without seroconversion illness and within a few years following seroconversion; this is associated with the benefits of slower CD4 cell count decline and improved long-term prognosis. Such persons should be targeted for in depth investigation.
Madec
Yoann
Y
Epidemiology Department, INSERM U569/ INED/Paris XI, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France. ymadec@pasteur.fr
Boufassa
Faroudy
F
Porter
Kholoud
K
Meyer
Laurence
L
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology / Q000401:mortality / Q000821:virology; D000328:Adult; D018791:CD4 Lymphocyte Count / Q000379:methods*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality / Q000821:virology; D006679:HIV Seropositivity / Q000276:immunology / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012367:RNA, Viral / Q000097:blood; D012737:Sex Factors; D013997:Time Factors; D019562:Viral Load; D014766:Viremia / Q000276:immunology
D012367:RNA, Viral