A six-year follow-up of HIV-infected homosexual men with lymphadenopathy. Evidence for an increased risk for developing AIDS after the third year of lymphadenopathy
J. E. Kaplan, T. J. Spira, D. B. Fishbein, L. H. Bozeman, P. F. Pinsky and L. B. Schonberger
Division of Viral Diseases, Centers for Disease Control, Atlanta, GA 30333.
Seventy-five homosexual men with generalized lymphadenopathy for at least
three months (lymphadenopathy syndrome [LAS]), subsequently shown to be
seropositive for antibody against human immunodeficiency virus, were
enrolled in a prospective study in Atlanta in 1982 and 1983. As of Nov 30,
1987, twenty-two (29%) of the 75 were known to have developed acquired
immunodeficiency syndrome (AIDS) three to 60 months after enrollment and
five to 69 months after onset of LAS. The six-year cumulative incidence of
AIDS, by Kaplan-Meier survival analysis, was 38%. The cumulative incidence
in years 4, 5, and 6 (30%) was significantly higher than in years 1, 2, and
3 (11%), suggesting that the risk for AIDS increases after the third year
of LAS and that many more study participants will eventually develop AIDS.
A precipitous decline in the T-helper cell count frequently heralds the
diagnosis of AIDS; this decrease appears to occur at different times after
the onset of LAS in different persons. The four-year cumulative incidence
of AIDS following observations of T-helper cell counts less than 200/mm3,
200 to 299/mm3, 300 to 399/mm3, and 400/mm3 or greater was 84%, 41%, 25%,
and 18%, respectively; these data are important for determining prognosis
in the individual patient as well as for determining the suitability of
candidates and baseline data for drug trials.
