John W. Mellors, MD; Lawrence A. Kingsley, DrPH; Charles R. Rinaldo, PhD; John A. Todd, PhD; Brad S. Hoo, MS; Robert P. Kokka, DrPH; Phalguni Gupta, PhD
Mellors JW, Kingsley LA, Rinaldo CR, Todd JA, Hoo BS, Kokka RP, et al. Quantitation of HIV-1 RNA in Plasma Predicts Outcome after Seroconversion. Ann Intern Med. 1995;122:573-579. doi: 10.7326/0003-4819-122-8-199504150-00003
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Published: Ann Intern Med. 1995;122(8):573-579.
To investigate the relation between the quantity of human immunodeficiency virus type 1 (HIV-1) RNA in plasma and the risk for the acquired immunodeficiency syndrome (AIDS) or a decline in the CD4+ T-cell count after seroconversion.
62 homosexual men with documented HIV-1 seroconversion.
University outpatient setting.
Clinical status, CD4+ T-cell counts, and plasma and serum samples were obtained every 6 months. Human immunodeficiency virus RNA in plasma was quantitated with a branched-DNA (bDNA) assay. Serum samples were assayed for neopterin, β2-microglobulin, and immune complex dissociated HIV-1 p24 antigen.
18 of 62 (29%) men developed AIDS; 21 (34%) had a significant decline in the CD4+ T-cell count without AIDS; and 23 [37%] had a stable CD4+ T-cell count. For each participant, HIV-1 RNA results were categorized into one of four groups: 1) detection of HIV-1 RNA (>1 × 104 genome equivalents/mL [Eq/mL]) in all samples; 2) detection in most samples [≥ 50%]; 3) detection in fewer than 50% of samples; and 4) detection in none of the samples. Detection of HIV-1 RNA in all or most samples was strongly associated with AIDS (16 of 18 patients) and a decline in the CD4+ T-cell count (13 of 21 patients) compared with a stable CD4+ T-cell count (4 of 23 patients; P < 0.001). Conversely, the absence of HIV-1 RNA (<1 × 104 Eq/mL) in all or most samples was associated with stable CD4+ T-cell counts (19 of 23 patients) and a lower risk for AIDS or decline in the CD4+ T-cell count (10 of 39 patients; P < 0.001). In multivariate analysis of all laboratory values at the seroconversion visit, a plasma HIV-1 RNA level greater than 1 × 105 Eq/mL was the most powerful predictor of AIDS (odds ratio, 10.8; P = 0.01).
Plasma HIV-1 RNA is a strong, CD4+ T-cell-independent predictor of a rapid progression to AIDS after HIV-1 seroconversion.
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HIV, Infectious Disease.
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