PROSPECTIVE LONGITUDINAL ANALYSIS OF VIRAL LOAD AND SURROGATE MARKERSIN RELATION TO CLINICAL PROGRESSION IN HIV TYPE 1-INFECTED PERSONS

The temporal relationship between viral and surrogate markers and clin ical status was analyzed prospectively every 8 weeks in 34 asymptomati c HIV-1-infected persons, After 3 years, 25 persons remained clinicall y healthy whereas 9 persons showed clinical progression, In accordance with other reports we found that at study entry HIV-RNA load was pred ictive of clinical progression, All markers tested evolved significant ly in time in both progressors and nonprogressors. The HIV RNA load in plasma and HIV DNA load in T cells were linearly related only in nonp rogressors. In addition, the RNA/DNA ratio during follow-up was signif icantly higher in progressors, indicating a higher replication rate in progressors. The HIV DNA load correlated inversely with CD4(+) T cell counts and positively with p24 antigenemia in both nonprogressors and progressors. A significant correlation of HIV DNA load,vith SI phenot ype occurred in progressors only, HIV RNA levels correlated,vith beta( 2)-microglobulin level and with p24 antigenemia but not with SI phenot ype, These three markers can all routinely be measured in plasma; howe ver, only the HIV RNA levels appear to be informative for clinical pro gression, Six to 8 months before clinical progression, an SI phenotype switch, increased HIV RNA in plasma, and decreased CD4(+) T cell coun ts were all indicative of an impending clinical event.