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August 16, 1995

Natural History of HIV-1 Cell-Free Viremia

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.

JAMA. 1995;274(7):554-558. doi:10.1001/jama.1995.03530070052029

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 103.8 copies/mL if AIDS occurred in less than 4 years, 103.07 copies/mL if AIDS developed within 4 through 9 years, and 102.27 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)