ABSTRACT
A cohort of 103 human immunodeficiency virus type 1 (HIV-1)-infected persons with well-defined dates of seroconversion were studied to determine whether baseline plasma HIV RNA loads 6-12 months after seroconversion have prognostic value. Baseline plasma virus loads had predictive value for the disease-free survival rate and for the survival rate. The level of baseline HIV RNA also had a strong negative predictive value for the CD4+ T cell count during the fifth year of infection: A baseline load >5 log was predictive of a CD4+ T cell count <500/mm3 5 years after infection. Baseline HIV RNA load was a CD4+ T cell-independent predictor of progression to death. The major finding was that the disease outcome for HIV-1-infected persons is already determined during the first year of infection.
Subject(s)
HIV Infections/physiopathology , HIV-1 , Viral Load , Adult , CD4 Lymphocyte Count , Cohort Studies , Disease Progression , Female , Follow-Up Studies , HIV Infections/immunology , HIV Infections/mortality , HIV Infections/virology , HIV-1/genetics , Humans , Longitudinal Studies , Male , Middle Aged , Predictive Value of Tests , Prognosis , RNA, Viral/blood , Risk Factors , Survivors , Time FactorsABSTRACT
BACKGROUND: One of the aims of the medical interview routinely preceding each blood donation is the identification of individuals with a risk factor for infection with the human immunodeficiency virus (HIV). STUDY DESIGN AND METHODS: Interviews were performed with individuals diagnosed as being seropositive for HIV through the systematic biologic screening of blood donations in the Paris area to establish, first, the circumstances allowing HIV-seropositive individuals to pass through the predonation medical interview and, second, the motivation of these individuals as blood donors. Risk factors of 30 HIV-infected donors identified between 1991 and 1994 were determined. RESULTS: When asked whether they recognized the eventual risk to recipients of donated blood, 14 (47%) of 30 answered positively. Fifteen (50%) admitted having given their blood to determine their HIV status. CONCLUSION: These individuals did not exclude themselves from blood donation and probably hid their risk factor(s) at the predonation interview in order to be accepted as blood donors.
Subject(s)
Blood Donors , HIV Seropositivity , Adult , Female , Humans , Male , Middle Aged , Motivation , Paris , Risk FactorsABSTRACT
In order to establish whether the Polymerase Chain Reaction (PCR) may constitute a new marker of evolution towards AIDS in symptomless HIV infected subjects, we used PCR with three primer pairs (in the gag, pol and LTR regions) in 223 seropositive individuals at different stages of HIV infection. Among 176 symptomless seropositive individuals, 174 (98.8%) were positive with at least one primer pair. The subjects negative with at least one primer pair had a CD4 lymphocyte count significantly higher (p less than 0.01), and serum immunoglobulin G, immunoglobulin A, neopterin and beta-2-microglobulin concentrations significantly lower (p less than 0.01) than the individuals positive with the three primer pairs. Among 73 seropositive individuals followed over a two year period, 59 presented the same PCR pattern over this time period, while PCR showed different results in 14. Forty-seven AIDS patients were positive with the three primer pairs. The number of PCR negative with at least one primer pair was significantly fewer (p less than 0.001) in symptomatic individuals than in symptomless individuals. We conclude that the percentage of positive PCR results in HIV infected individuals is linked to the clinical stage of infection and to the disease progression.
