HIV-1 RNA levels and development of clinical disease in two different adolescent populations

HIV infection rates in American youth continue to increase unabated. As ado lescent-specific therapeutic interventions are planned, information on HIV infection's course and its predictors becomes critically important for vali d and precise study design. We report on age-specific disease rates stratif ied by estimated time since infected and predictors of HIV disease progress ion through four clinical categories in two distinct adolescent populations . Adolescents with hemophilia infected through contaminated blood products showed disease progression rates of 18 to 23 events per 100 person-years (P Ys) by age and years infected. Predictors of first progression included HIV -1 RNA >30,000 copies/ml (rate ratio [RR], 2.4; 95% confidence interval [CI ], 1.5-3.9), antiretroviral monotherapy (RR, 2.4; 95% CI, 1.7-3.3); Latino/ a ethnicity (RR, 2.2; 95% CI, 1.2-4.2) and initial intermediate clinical st atus (RR, 1.9; 95% CI, 1.3-2.9). Sexually-infected adolescents >18 years wh o had been infected >3 to 6 years had a disease progression rate of 16 even ts per 100 PY. For these youths, the sole predictor of first progression wa s viral load (VL) (RR for VL >30,000 copies per ml, 8.4; 95% CI, 2.8-25.1). This article examines the predictive capacity of viral load and evaluates other cofactors for disease progression in different adolescent populations . These data will be of value in clinical trial design.