LONGITUDINAL HIV-1 RNA LEVELS IN A COHORT OF HOMOSEXUAL MEN

HIV-1 RNA levels measured during early chronic infection strongly pred iet subsequent clinical events. In the short term, HIV-I is in a stead y stale, but the stability of viral levels over time is incompletely u nderstood. We used reverse transcriptase polymerase chain reaction (RT -PCR) to examine changes in serum HIV-I RNA levels in 111 HIV-l-infect ed homosexual men during the period from 1982 to 1992 and their relati on to clinical outcomes. HIV-I RNA levels increased by a median of 0.0 8 log(10) copieslmliyear (p = .0001). HIV-1 RNA levels rose either gra dually or abruptly for the majority of subjects; 41% had no increase. Among subjects surviving at least 8 years, HIV-1 RNA was stable during the first 4 years after seroconversion (median, 0.00 log(10) copies/m l/year), but rose in years five through eight (median, 0.06 log(10) co pies/ml/year; p = .04). The annual HIV-1 RNA level was more predictive of AIDS (relative hazard [RH], 1.75 per 0.5 log difference; 95% confi dence interval [CI], 1.38-2.21; likelihood ratio [LR], 26.2) than the initial level alone (RH, 1.39; 95% CI, 1.10-1.76; LR, 8.5). We conclud e that most HIV-1-infected persons lack a long-term viral setpoint and that failure to account for evolution of the viral level can lead to underestimation of the risk of progression.