Predictors of disease progression in HIV-infected homosexual men with CD4+ cells < 200 x 10(6)/l but free of AIDS-defining clinical disease.

Abstract

OBJECTIVE:

To study progression of HIV infection in individuals who are free of AIDS-defining clinical disease with CD4+ cell counts < 200 x 10(6)/l.

DESIGN:

Prospective and nested case-control study.

SETTING:

Amsterdam cohort study on HIV infection, The Netherlands.

PARTICIPANTS:

Prospective study: 148 asymptomatic HIV-infected individuals with < 200 x 10(6)/l CD4+ cells. Nested case-control study: 58 men with AIDS-free follow-up more than 2 years after CD4 count < 200 x 10(6)/l, compared with 63 who progressed to AIDS within 2 years.

MAIN OUTCOME MEASURES:

Progression to AIDS according to the 1987 Centers for Disease Control and Prevention case definition and death.

RESULTS:

Median AIDS-free interval was 22 months, median interval to death 41 months. Presence of syncytium-inducing (SI) HIV variants, HIV p24 antigen, and a low T-cell response after stimulation with phytohaemagglutinin (PHA) were independent predictors of progression to AIDS. Probability of 1 year AIDS-free survival varied between 89 and 38% by the presence or absence of these additional markers. Effect of early treatment could only be detected in men with HIV p24 antigen and SI variants. Case-control analysis showed similar changes over time regarding prognostic markers in both groups although at a lower rate in the AIDS-free men. Eight men remained AIDS-free more than 4 years, SI variants were absent in seven, and all eight were p24-seronegative.

CONCLUSIONS:

HIV-infected individuals can remain disease-free for more than 4 years with very low CD4+ cell counts, provided that they lack other progression markers: SI variants, p24 antigen and a low PHA-induced T-cell reactivity. A beneficiary effect of early treatment may be limited to men with SI variants and/or p24 antigen.

• Authors: I P Keet, A Krol, M Koot, M T Roos, F de Wolf, F Miedema, R A Coutinho
• Journal: AIDS (London, England) (AIDS) Vol. 8 Issue 11 Pg. 1577-83 (Nov 1994) ISSN: 0269-9370 [Print] England
• PMID: 7848594 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• HIV Core Protein p24

Topics

• Acquired Immunodeficiency Syndrome (immunology, physiopathology)
• Analysis of Variance
• CD4 Lymphocyte Count
• Case-Control Studies
• Follow-Up Studies
• HIV Core Protein p24 (blood)
• HIV Infections (immunology, mortality, physiopathology)
• HIV Seropositivity (immunology, mortality, physiopathology)
• HIV-1
• Homosexuality, Male
• Humans
• Lymphocyte Activation
• Male
• Multivariate Analysis
• Predictive Value of Tests
• Probability
• Proportional Hazards Models
• Prospective Studies
• Survival Analysis
• T-Lymphocytes (immunology)
• Time Factors