Document 0771
 DOCN  M9550771
 TI    Predictors of disease progression in HIV-infected homosexual men with
       CD4+ cells < 200 x 10(6)/l but free of AIDS-defining clinical disease.
 DT    9505
 AU    Keet IP; Krol A; Koot M; Roos MT; de Wolf F; Miedema F; Coutinho RA;
       Municipal Health Service, Department of Public Health and; Environment,
       Amsterdam, The Netherlands.
 SO    AIDS. 1994 Nov;8(11):1577-83. Unique Identifier : AIDSLINE MED/95151235
 AB    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.
 DE    Acquired Immunodeficiency Syndrome/*IMMUNOLOGY/PHYSIOPATHOLOGY  Analysis
       of Variance  Case-Control Studies  *CD4 Lymphocyte Count  Follow-Up
       Studies  Homosexuality, Male  Human  HIV Core Protein p24/BLOOD  HIV
       Infections/*IMMUNOLOGY/MORTALITY/PHYSIOPATHOLOGY  HIV
       Seropositivity/*IMMUNOLOGY/MORTALITY/PHYSIOPATHOLOGY  *HIV-1  Lymphocyte
       Transformation  Male  Multivariate Analysis  Predictive Value of Tests
       Probability  Proportional Hazards Models  Prospective Studies  Support,
       Non-U.S. Gov't  Survival Analysis  T-Lymphocytes/IMMUNOLOGY  Time
       Factors  CLINICAL TRIAL  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).