Course of viral load throughout HIV-1 infection

HIV-1 RNA levels are routinely monitored as part of patient management. How ever, little is known about the course of HIV-1 RNA levels over the entire period of infection. The aim of this study was to investigate the course of HIV-1 RNA levels in a cohort of men with hemophilia who were observed for up to 17 years after HIV-1 seroconversion, and to assess the risk of HIV di sease progression at any HIV-1 RNA level. Viral loads were measured on annu al stored serum samples in 107 men with hemophilia A using the Roche Amplic or Monitor assay with non-B primers. On average, HIV-1 RNA levels increased significantly by 0.11 log(10) per year over the course of HIV infection. T his rate of increase was significantly faster in those who developed AIDS o r died over the subsequent 12 to 17 year period, and in those who were olde r at HIV-1 seroconversion. The risk of developing AIDS and death remained l ow when the HIV-1 RNA level was below 4 log(10) copies/ml, but increased ra pidly thereafter, supporting current guidelines for the initiation of antir etroviral therapy after the viral load has exceeded this level.