Rapid clearance of HIV-1 is associated with decreased risk of AIDS

A study of 22 patients with acute infection from the Trinidad Seroconvertor Cohort in Port of Spain, Trinidad, concludes that efficient, early clearance of HIV-1 strongly predicts subsequent risk of progression to AIDS. This finding is consistent with a growing body of evidence suggesting that effective immune responses during the earliest phase of infection are important determinants of disease progression.

William Blattner and colleagues in Trinidad and the United States found that 10 patients developed AIDS-defining events. In univariate analysis, progression to AIDS was associated with rate of initial HIV clearance (P = .002), virus load during set point (P = .008), and CD4+ cell count during steady state (P = .04).

Multivariate analysis showed that a rapid rate of initial clearance was the sole independent predictor of subsequent progression to AIDS and was associated with a 92% reduction in the risk of AIDS. The rate of initial clearance was inversely correlated with the number of early symptoms (r = -0.66; P = .0008). However, symptoms did not predict subsequent risk of AIDS.

Comment

This study presents interesting data, but in clinical practice the monitoring of CD4 will be still the most relevant strategy. There will be considerable variation in the natural course of the disease even after inclusion of viral clearance in patients with known time of infection.

Blattner W, Oursler KA, Cleghorn F et al. Rapid clearance of virus after acute HIV-1 infection: correlates of risk of AIDS. JID 2004;189:1793-1801