Ovid: Welcome to Ovid

Articles: Prognostic Value of HIV-1 Syncytium-inducing Phenotype for Rate of CD4+ Cell Depletion and Progression to AIDS.
Koot, Maarten; Keet, Ireneus P. M.; Vos, Aster H. V.; de Goede, Ruud E. Y.; Roos, Marijke Th. L.; Coutinho, Roel A.; Miedema, Frank; Schellekens, Peter Th. A.; Tersmette, Matthijs
[Article] Annals of Internal Medicine. 118(9):681-688, May 1, 1993.

(Format: HTML, PDF)

Objective: To investigate the relation between detection of syncytium-inducing (SI), human immunodeficiency virus type 1 (HIV-1) variants, rate of CD4 cell decline, and clinical progression.

Design: Prospective studyduring a 2.5-year follow-up period; cohort study with pairwise matched controls.

Setting: The Amsterdam cohort study on the course of HIV-1 infection in homosexual men.

Participants: Asymptomatic HIV-1-infected men sup (n = 225) were tested for the presence of SI variants and were studied prospectively for CD4 cell decline and clinical progression. In addition, 45 men with a defined moment of appearance of SI variants and45 matched controls without SI variants were compared for CD4 cell decline.

Measurements: Syncytium-inducing variants were detected by cocultivation ofperipheral blood mononuclear cells with the MT-2 T-cell line.

Results: During a 30-month period, 70.8% of the men with SI variants progressed to AIDS, comparedwith 15.8%of men without SI variants at entry (P <0.0001). Multivariable Cox proportional hazard analysis, controlling for CD4 cell count and HIV-p24 antigenemia,showed a relative hazard for SI variants of 6.7 (95% CI, 3.5 to 12.7). In the matched control study, before the appearance of SI variants, CD4 cell counts of 45 men with SI variants and their controls were compared. Syncytium-inducing variants emerged at a mean CD4 cell count of 0.48 x 109/L (CI, 0.42 to 0.54),coinciding with the onset of a threefold (increased) rate of CD4 cell decline. Men developing AIDS with SI variants had decreased CD4 cell counts (0.08 x 109/L; 95% CI, 0.05 to 0.12)at the time of diagnosis compared with persons progressing to AIDS without SI variants (0.25 x 109/L; 95% CI, 0.15 to 0.41) (P = 0.0035).

Conclusions: The HIV-1 biological phenotype is a practical, binary marker forprogression to AIDS, which is independent of decreased CD4 ( ) cell counts and antigenemia. Appearance of SI variants, occurring 2 years before progression to AIDS on the average, is predictive for a significantly increased rate of CD4 cell decline.