The median interval between HIV-1 infection and the development of AIDS is 10 to 11 years, yet some infected persons progress to AIDS in less than 5 years (rapid progresssors). Still others remain asymptomatic without evidence of immunologic decline for more than a decade (long term non-progressors). This variable course of infection causes prognostic uncertainty for the infected individual. Quantitation of circulating HIV-1 RNA levels either by polymerase chain reaction (PCR), nucleic acid sequence based on amplification (NASBA) or branched DNA (bDNA) signal amplification holds promise as an early predictor of disease progression. Many cross-sectional studies have shown a strong positive correlation between disease stage and the amount of circulating HIV-1 RNA. In addition, longitudinal studies of long-term non-progressors have shown HIV-1 RNA to remain at low levels, generally less than 1,000 copies/ml. In one natural history study of 62 HIV-1 seroconverters enrolled in the multicenter AIDS cohort study (MACS),HIV-1 RNA level greater than 100,000 copies/ml at the visit of seroconversion was associated with an 11-fold increased risk of rapid progression to AIDS. This finding suggests that HIV-1 RNA is an early marker of AIDS risk, but larger longitudinal studies are necessary to define more precisely the relationship between HIV-1 RNA level and AIDS risk. Recent data from the MACS addressing this question will be presented.

Cohort Studies DNA, Viral/BLOOD Disease Progression HIV Infections/PHYSIOPATHOLOGY/*VIROLOGY HIV-1/GENETICS/*ISOLATION & PURIF Human Longitudinal Studies Polymerase Chain Reaction Prognosis RNA, Viral/BLOOD ABSTRACT

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