TRANSIENT HIGH TITERS OF HIV-1 IN PLASMA AND PROGRESSION OF DISEASE

Periodic quantitative HIV-1 plasma cultures were performed on 28 serop ositive individuals who had CD4 cells less than or equal to 300/mm(3) and who were enrolled in three clinical trials testing the efficacy of didanosine versus zidovudine monotherapy. Most plasma cultures were n egative or of low titer (1-100 tissue culture infective dose/ml of pla sma), but there were 14 instances of high-titered plasma viremia (grea ter than or equal to 1,000 tissue culture infective dose/ml of plasma) seen in 11 individuals. These peaks in plasma culture titers were sig nificantly associated either with rapidly decreasing CD4 cell numbers or with CD4 cells already <50/mm(3). In addition, patients who experie nced these episodes of high-titered plasma viremia were more apt to ha ve clinical complaints of fever, rash, flulike illness, and/or opportu nistic infection and also the syncytium-inducing HIV-1 phenotype and p rogression of disease.