Serum HIV-1 RNA levels and time to development of AIDS in the Multicenter Hemophilia Cohort Study

JAMA. 1996 Jul 10;276(2):105-10.

Abstract

Objective: To determine if the long-term incidence of the acquired immunodeficiency syndrome (AIDS) is related to human immunodeficiency virus type 1 (HIV-1) RNA levels measured early in HIV-1 infection.

Design: Epidemiologic cohort study.

Setting: Five hemophilia treatment centers in the United States.

Subjects: A total of 165 subjects with hemophilia and HIV-1 infection (age at HIV-1 seroconversion, 1-66 years) followed from 1979 to 1995.

Methods: The HIV-1 RNA level was measured by polymerase chain reaction over a range of 200 to 1 million or more HIV-1 RNA copies/mL in archived serum specimens collected 12 to 36 months (median, 27 months) after the estimated date of HIV-1 seroconversion. Kaplan-Meier methods were used to examine the risk of AIDS and proportional hazards models were used to estimate relative hazards.

Results: The HIV-1 RNA values were similar in subjects younger than 17 years at seroconversion (median, 5214 copies/mL) and those 18 to 34 years old (median, 4693 copies/mL), but higher in those 35 years or older (median, 12069 copies/mL) (P = .02 compared with each younger group). At 10 years after seroconversion, the proportions of subjects with AIDS were 72% among subjects with 100,000 or more HIV-1 RNA copies/mL measured 12 to 36 months after HIV-1 seroconversion (n = 9), 52% among subjects with 10,000 to 99,999 copies/mL (n = 55), 22% among subjects with 1000 to 9,999 copies/mL (n = 82), and 0% among subjects with fewer than 1000 copies/mL (n = 19) (P < .001). The age-adjusted relative hazard for AIDS for subjects with 10,000 or more copies/mL was 14.3 (95% confidence interval, 1.9-105.6) compared with subjects with fewer than 1000 copies/mL.

Conclusions: The HIV-1 RNA level during early chronic HIV-1 infection is a strong, age-independent predictor of clinical outcome; low levels define persons with a high probability of long-term AIDS-free survival.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acquired Immunodeficiency Syndrome / blood
  • Acquired Immunodeficiency Syndrome / complications
  • Acquired Immunodeficiency Syndrome / mortality*
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Child
  • Child, Preschool
  • Cohort Studies
  • Disease Progression
  • HIV Seropositivity / blood*
  • HIV Seropositivity / complications
  • HIV Seropositivity / mortality
  • HIV-1 / genetics*
  • Hemophilia A / complications
  • Humans
  • Infant
  • Longitudinal Studies
  • Middle Aged
  • Polymerase Chain Reaction
  • Prognosis
  • Proportional Hazards Models
  • RNA, Viral / blood*
  • Survival Analysis
  • Time Factors

Substances

  • RNA, Viral