AIDS PROGNOSIS BASED ON HIV-1 RNA, CD4-CELL COUNT AND FUNCTION - MARKERS WITH RECIPROCAL PREDICTIVE VALUE OVER TIME AFTER SEROCONVERSION( T)

Objective: HIV-1 RNA levels in peripheral blood are strongly associate d with progression to AIDS, CD4+ T-cell decline, or death. Their predi ctive value is reportedly independent of the predictive value of CD4T-cell counts. Because the interrelations between these parameters of HIV-1 infection are poorly understood, we studied the kinetics and pre dictive value of serum HIV-1 RNA levels, CD4+ T-cell counts, and T-cel l function. Design and methods: HIV RNA levels, CD4+ T-cell counts, an d T-cell function were measured from seroconversion to AIDS in 123 hom osexual men who seroconverted during a prospective study and were foll owed over 10 years. Results: Two patterns of median HIV-1 RNA levels w ere found during infection: a steady-state and a `U-shaped' curve. Ste ady-state high RNA levels were related to rapid disease progression. F or the U-shaped curve, there were groups with high and low RNA levels related to disease progression. At 1 year after seroconversion, RNA le vel was the only marker that was strongly predictive. Furthermore, dec reasing RNA levels in the first year following seroconversion were rel ated to better prognosis than stable low levels. Low CD4+ T-cell count and T-cell function became predictive of progression to AIDS at 2 and 5 years after seroconversion, respectively. Conclusions: With ongoing infection, the predictive value of low CD4+ T-cell count and T-cell f unction increases, whereas the predictive value of high HIV-1 RNA leve l decreases. These findings reflect the observation that infection wit h HIV progressively leads towards immune deficiency, which in later st ages is most predictive of disease progression.