Second International Congress Drug Therapy in HIV Infection 18-22 November 1994 Glasgow, UK

CHARACTERIZATION OF RAPID AND SLOW PROGRESSORS IN A COHORT OF HIV-INFECTED INDIVIDUALS IN MADRID.

Soriano V, Hartin R, Del Romero J, Martinez P, Valencia E, Thompson M, Gutierrez H, Bru F, Bravo R, Moreno V, Laguna F, Bernal A, Sabin M'L, Gonzalez-Lahoz J.
Services of Infectious Diseases, Microobiology and Hematology, Centro Investigaciones Clinicas, Instituto de Salud Carlos III, Madrid CPS Centro, Ayuntamiento de Haddd. Centro Sandoval, Comunidad de Madrid. Laboratory of Tumor Cell Biology, NCI, NIH, Bethesda, MD, USA. CNBCR, Instituto Salud Carlos III, Madrid, Spain.

Int Cong Drug Therapy HIV 1994 Nov 18-22;2:Abstract No. 2.5
AIDS 1994, Vol. 8 (Suppl. 4);S2

OBJECTIVE: Recent reports have pointed that some individuals with confirmed HIV" infection may certain asymptomatic and with normal CD4+ T cell count for long periods of time. In contrast, co4+ fall and AIDS seems to occur" faster in Africans and some HIV-infected subjects. In order to knows rate and factors associated with slow and rapid progression to AIDS, we study a cohort of 3,600 HIV-1 individuals on follow-up in three reference centers placed in Madrid, Spain.

METHODS: Criteria for "slow processors" (SP) were more than 7 years of confirmed HIV-' infection, and > 500 CD4+ cells/μL in at least two determinations in the last 3 months, and without antiretroviral therapy. "Rapid progressors (RP) were those infected no more than in the last 5 years, and showing repeatedly < 200 CD4+ cells/μL.

Eight percent of the study population fulfilled criteria for SP, and 4% met criteria for RP.

RESULTS: In a preliminary evaluation, high CD8+ cell count, elevated CD45RO+ CD4+ subpopulation, NSI strains, low viral load, absence of antigenemia, and high anti-p24 titers were the most characteristic features of SP compared to RP. In contrast, old age, heterosexual HIV-1 transmission from patients ongoing AZT therapy, female gender, high Igs levels (particularly IgA), S1 strains, elevated triglicerid levels, B2-MG, high HIV-Ag levels, and high viral load were associated to RP. In this study, hepatitis B and C viruses, not seems to influence the course of HIV-1 infection. Molecular studies regarding the expression of spliced/unspliced mRNA of different HIV-1 regulatory genes still are in progress, and will be presented in the meeting.

CONCLUSIONS: This study supports both biphasic natural history and the suggestion that the broad range in the progression rates may be the result of several independent factors (from environment, the host, and the virus itself). Whether some of these parameters are merely an epiphenomenon of the underlying immunodeficiency or indicates an active role of them in the pathogenesis of the immune deficit associated with AIDS needs to be elucidated. Recent infection with more virulent HIV strains, e.g. required from subjects ongoing antiretroviral therapy or in late stages of disease, seems to be associated with the poorer prognosis in this cohort.

1994-11-18
2.5

Originally published in AIDS Volume 8, Supplement 4 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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