Natural history of human immunodeficiency virus type 1 viremia after seroconversion and proximal to AIDS in a large cohort of homosexual men

The natural history of human immunodeficiency virus type 1 (HIV-1) viremia and its association with clinical outcomes after seroconversion was charact erized in a cohort of homosexual men. HIV-1 RNA was measured by reverse-tra nscription polymerase chain reaction (RT-PCR) in stored longitudinal plasma samples from 269 seroconverters. Subjects were generally antiretroviral dr ug naive for the first 3 years after seroconversion. The decline in CD4 lym phocyte counts was strongly associated with initial HIV RNA measurements. B oth initial HIV RNA levels and slopes were associated with AIDS-free times. Median slopes were +0.18, +0.09, and -0.01 log(10) copies/mL, respectively , for subjects developing AIDS <3, 3-7, and >7 years after seroconversion. In contrast, HIV RNA slopes in the 3 years preceding AIDS and HIV RNA level s at AIDS diagnosis showed little variation according to total AIDS-free ti me. HIV RNA load at the first HN-seropositive visit (similar to 3 months af ter seroconversion) was highly predictive of AIDS, and subsequent HIV RNA m easurements showed even better prognostic discrimination.