Quantitation of HIV-1 RNA in plasma predicts outcome after seroconversion

Ann Intern Med. 1995 Apr 15;122(8):573-9. doi: 10.7326/0003-4819-122-8-199504150-00003.

Abstract

Objective: 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.

Design: Prospective study.

Patients: 62 homosexual men with documented HIV-1 seroconversion.

Setting: University outpatient setting.

Measurements: 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, beta 2-microglobulin, and immune complex dissociated HIV-1 p24 antigen.

Results: 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 x 10(4) genome equivalents/mL [Eq/mL]) in all samples; 2) detection in most samples (> or = 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 x 10(4) 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 x 10(5) Eq/mL was the most powerful predictor of AIDS (odds ratio, 10.8; P = 0.01).

Conclusions: Plasma HIV-1 RNA is a strong, CD4+ T-cell-independent predictor of a rapid progression to AIDS after HIV-1 seroconversion.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acquired Immunodeficiency Syndrome / blood
  • Acquired Immunodeficiency Syndrome / virology
  • Biopterin / analogs & derivatives
  • Biopterin / blood
  • CD4 Lymphocyte Count
  • HIV Core Protein p24 / blood
  • HIV Seropositivity / blood
  • HIV Seropositivity / virology*
  • HIV-1 / isolation & purification*
  • Humans
  • Male
  • Neopterin
  • Pilot Projects
  • Polymerase Chain Reaction
  • Prognosis
  • Prospective Studies
  • RNA, Viral / blood*
  • Risk Factors
  • beta 2-Microglobulin / metabolism

Substances

  • HIV Core Protein p24
  • RNA, Viral
  • beta 2-Microglobulin
  • Biopterin
  • Neopterin