PATTERNS OF VIRUS BURDEN AND T-CELL PHENOTYPE ARE ESTABLISHED EARLY AND ARE CORRELATED WITH THE RATE OF DISEASE PROGRESSION IN HUMAN-IMMUNODEFICIENCY-VIRUS TYPE 1-INFECTED PERSONS

Human immunodeficiency virus (HIV)-1 DNA and RNA levels and T lymphocy te cell surface markers were measured in blood serum and cell fraction s from asymptomatic infected patients to find novel virologic and immu nologic features in early disease predictive of subsequent clinical di sease course, Thirty-two patients with rapid disease progression (rapi d CD4(+) cell loss and progression to clinical AIDS) were compared wit h 25 patients with stable infections (constant or rising CD4(+) cell c ounts, no clinical disease manifestations). All HIV-1 burdens measured by polymerase chain reaction were consistently higher in specimens fr om rapid progressors than slow progressors. For each patient, virus bu rden remained relatively constant throughout the study period (mean, 4 2-44 months), Flow cytometry also disclosed stable lymphocyte immunoph enotype patterns that correlated strongly with subsequent rapid progre ssion to clinical disease, Thus, in early HIV-1 infection, a constella tion of high virus burden and in vivo costimulatory antigen and lympho cyte activation abnormalities is predictive of a rapid disease course.