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Factors affecting HIV progression

John G Bartlett, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Howard Libman, MD, FACP


As of 2009, the World Health Organization (WHO) estimated that approximately 33 million people are living with HIV/AIDS [1]. From early in the HIV epidemic, it was clear that some patients rapidly progressed to AIDS while others experienced relative immunologic stability.

Laboratory measurements, such as numbers of CD4 cells and levels of plasma HIV RNA, are helpful in determining the stage of infection and may serve as prognostic markers. Other factors may also influence outcome. This topic covers the demographic, viral, and host factors that may play a role in disease progression as well as describing the important impact antiretroviral therapy has had over the past decade.

The relative stages of HIV infection are discussed elsewhere. (See "The natural history and clinical features of HIV infection in adults and adolescents".)


Two important laboratory determinants of the rate of progression are the CD4 cell count and the plasma viral load, both of which are used clinically [2,3]. (See "Techniques and interpretation of measurement of the CD4 cell count in HIV-infected patients" and "Techniques and interpretation of HIV-1 RNA quantitation".)

CD4 counts and levels of HIV RNA — The average rate of decline of CD4 cells ("CD4 slope") is about 50/microL per year and the average viral burden (without therapy) is 30,000 to 50,000 copies/mL. The CD4 cell count and the viral load are independent predictors of progression [2-4]. This is illustrated by the following natural history studies prior to the era of potent antiretroviral therapy (ART) [4,5]:

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Literature review current through: Nov 2017. | This topic last updated: Oct 23, 2017.
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