LONG-TERM SURVIVORS WITH HIV-1 INFECTION - INCUBATION PERIOD AND LONGITUDINAL PATTERNS OF CD4(+) LYMPHOCYTES

To characterize long-term survival with HIV-1, we need to estimate the proportion of seroconverters remaining free from clinical AIDS for lo ng periods. We predict that similar to 13% of homosexual/bisexual men infected at a young age may remain so for >20 years. Since studies hav e not followed individuals for such periods, long-term survivors must be characterized using stability of immunologic markers. In a cohort o f 1,809 seropositive men followed since 1984-85, 15% (187/1,214) of th ose with at least two consecutive visits early in the study showed no decline in CD4(+) cell count. From these, 67 men with long follow-up a nd no use of zidovudine were identified as cases to investigate correl ates of protection against HIV-l-induced immunodepletion. Two matched control subgroups, one with moderate and one with rapid CD4(+) lymphoc yte decline, produced 56 triplets of individuals to be contrasted. Ana lysis of data from early in the study on demographics, sexual behavior , and sexually transmitted diseases revealed no significant difference s among the three groups. Men showing no decline in CD4(+) lymphocytes persistently showed a healthier profile with respect to onset of clin ical AIDS, survival, and concomitant hematologic variables. Moderate d ecliners had rates of clinical AIDS and death significantly higher tha n those in the stable group but lower than the fast decliners.