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Denis R. Henrard, PhD; Jack F. Phillips, MS; Larry R. Muenz, PhD; William A. Blattner, MD; Dallas Wiesner, MS; M. Elaine Eyster, MD; James J. Goedert, MD

JAMA. 1995;274(7):554-558.

Abstract
Objective.
—To characterize the natural history of viremia with human immunodeficiency virus type 1 (HIV-1) and its association with disease progression from infection to acquired immunodeficiency syndrome (AIDS).

Design.
—Prospective cohort study. Annual specimens were tested for quantitative virion-associated HIV-1 RNA, p24 antigen, and CD4⁺ lymphocyte levels.

Participants.
—A total of 42 homosexual men who seroconverted to HIV-1 between 1982 and 1985.

Main Outcome Measures.
—Trends over time in serum HIV-1 RNA level, correlations between serum HIV-1 RNA and other markers, and prediction of AIDS using these markers.

Results.
—HIV-1 RNA levels were stable overtime, increasing by 10-fold or more in only six (14%) of the 42 subjects during 3 to 11 years of follow-up. Mean HIV-1 RNA levels were 10^3.8 copies/mL if AIDS occurred in less than 4 years, 10^3.07 copies/mL if AIDS developed within 4 through 9 years, and 10^2.27 copies/mL if AIDS did not develop within 6 through 11 years. In both univariate and multivariate models, initial and subsequent HIV-1 RNA levels, p24 antigenemia, and percentage of CD4⁺ lymphocytes were independently predictive of AIDS.

Conclusions.
—The stability of virion-associated HIV-1 RNA levels suggests that an equilibrium between HIV-1 replication rate and efficacy of immunologic response is established shortly after infection and persists throughout the asymptomatic period of the disease. Thus, defective immunologic control of HIV-1 infection may be as important as the viral replication rate for determining AIDS-free survival. Because individual steady-state levels of viremia were established soon after infection, HIV-1 RNA levels may be useful markers for predicting clinical outcome.

(JAMA. 1995;274:554-558)

Author Affiliations
From the Department of Medical Research, Abbott Laboratories, North Chicago, Ill (Dr Henrard and Messrs Phillips and Wiesner); Viral Epidemiology Branch, National Cancer Institute, Bethesda, Md (Drs Muenz, Blattner, and Goedert); and Division of Hematology, Department of Medicine, Milton S. Hershey Medical Center, Hershey, Pa (Dr Eyster). Dr Henrard is now with Institut Pasteur, Paris, France.

Footnotes
Reprint requests to Direction des Applications de la Recherche, Institut Pasteur, 25 rue du Dr Roux, 75724 Paris Cedex 15, France (Dr Henrard).

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