EARLY AND LATE HIV-1 RNA LEVEL AND ITS ASSOCIATION WITH OTHER MARKERSAND DISEASE PROGRESSION IN LONG-TERM AIDS-FREE HOMOSEXUAL MEN

Objective: To study the association between virological markers and cl inical progression in individuals with long-term AIDS-free HIV infecti on. Design: Seventy-seven HIV-infected participants in the Amsterdam c ohort study who remained AIDS-free for at least 8 years were prospecti vely followed during that time and during a subsequent period in which 15 developed AIDS. Methods: Serum HIV-1 RNA levels were evaluated atl and 8 years after study entry. Progression to AIDS following the 8 AI DS-free years was studied using Kaplan-Meier estimates and Cox proport ional hazard analysis. Results: HIV-1 RNA increased over rime in a lar ge proportion of these long-term AIDS-free men. Most subjects showed p rogressive immune system damage and/or clinical manifestations of HIV disease at year 8. High RNA levels at year 8 were significantly associ ated with symptomatic HIV infection, low CD4+ T-cell count, p24 antige naemia, low T-cell reactivity at year 8 as well as rapid annual CD4+ T -cell decline. High RNA level at year 1 was associated with high RNA l evels at year 8 and low CD4+ T-cell count at year 1. In univariate ana lysis, RNA was associated with progression to AIDS after 8 years. In m ultivariate analysis, only the CD4+-T-cell count at year 8 remained si gnificantly associated with progression to AIDS. Conclusions: In later stages of HIV infection, measures of immune deficiency may be more po werful prognostic markers than serum HIV-1 RNA level, indicating that optimal staging of the HIV-infected patient requires the combined use of RNA levels, CD4+-T-cell counts, and T-cell reactivity instead of RN A levels alone.