ABSTRACT: To clarify early correlates and natural history of HIV long-term nonprogressors (LTNPs) since HIV diagnosis.
Patients enrolled in the French ANRS SEROCO/HEMOCO cohort with CD4 count >500 cells/mm3 at HIV diagnosis. LTNP status was defined as being asymptomatic, antiretroviral free, and with CD4 cell count >500 cells/mm3 for >8 years after HIV diagnosis. In LTNPs, we modeled the biological markers' progression through a joint model. Factors associated with loss of LTNP status were identified through a Cox model.
Sixty (9%) of 664 patients were identified as LTNPs during follow-up. At enrollment, HIV RNA was <or=2.6 log copies/mL in 24% of LTNPs and HIV DNA was <or=1.85 log copies/10 peripheral blood mononuclear cells (PBMCs) in 31% vs. 3% and 8% in others. In LTNPs, HIV RNA and HIV DNA levels increased by 0.04 log copies/mL per year and 0.07 log copies/10(6) PBMCs per year during the first 8 years after diagnosis. LTNP status was lost in 36 subjects; baseline HIV DNA >1.85 log copies/10(6) PBMCs and high HIV DNA increase were associated with an increased risk of losing LTNP status [adjusted hazard ratio: 2.8 (1.2-6.8) and 2.2 (1.0-4.8), respectively].
LTNP status is established in the first years of HIV infection, low HIV DNA level at enrollment and slow increase of HIV DNA being associated with maintained LTNP status.
JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2009; 50(1):19-26. · 4.43 Impact Factor