Early and late HIV-1 RNA level and its association with other markers and disease progression in long-term AIDS-free homosexual men

Objective: To study the association between virological markers and clinical progression in individuals with long-term AIDS-free HIV infection. Design: Seventy-seven HIV-infected participants in the Amsterdam cohort study who remained AIDS-free for at least 8 years were prospectively followed during that time and during a subsequent period in which 15 developed AIDS. Methods: Serum HIV-1 RNA levels were evaluated atl and 8 years after study entry. Progression to AIDS following the 8 AIDS-free years was studied using Kaplan-Meier estimates and Cox proportional hazard analysis. Results: HIV-1 RNA increased over rime in a large proportion of these long-term AIDS-free men. Most subjects showed progressive immune system damage and/or clinical manifestations of HIV disease at year 8. High RNA levels at year 8 were significantly associated with symptomatic HIV infection, low CD4+ T-cell count, p24 antigenaemia, low T-cell reactivity at year 8 as well as rapid annual CD4+ T-cell decline. High RNA level at year 1 was associated with high RNA levels at year 8 and low CD4+ T-cell count at year 1. In univariate analysis, RNA was associated with progression to AIDS after 8 years. In multivariate analysis, only the CD4+-T-cell count at year 8 remained significantly associated with progression to AIDS. Conclusions: In later stages of HIV infection, measures of immune deficiency may be more powerful prognostic markers than serum HIV-1 RNA level, indicating that optimal staging of the HIV-infected patient requires the combined use of RNA levels, CD4+-T-cell counts, and T-cell reactivity instead of RNA levels alone.