Serum levels of human immunodeficiency virus type 1 (HIV-1) RNA after seroconversion: A predictor of long-term mortality in HIV infection

A cohort of 79 homosexual men with documented dates of human immunodeficiency virus type 1 (HIV-1) seroconversion and baseline CD4 cell counts of greater than or equal to 500/mu L were followed for up to 11.5 years. HIV-1 RNA was measured from stored sera obtained a median of 7 months after the estimated seroconversion date. AIDS progression and mortality among the men were studied, stratified by median baseline levels of HIV-1 RNA. AIDS progression rates at 11.5 years were 69% and 34%, respectively, among those with higher versus lower than median baseline virus loads (greater than or equal to 3040 copies/mL; P=.002), and mortality rates were 61% and 27%, respectively (P=.003). Survival curves continued to diverge throughout the 11.5 years, suggesting that the future clinical course of HIV-1 infection may already be determined at the earliest phases of disease, Initiation of definitive treatment very early in HIV-1 infection may be essential.