AEGiS-13IAC: Initial HIV-1 plasma RNA level after seroconversion does not predict progression to AIDS in women.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Initial HIV-1 plasma RNA level after seroconversion does not predict progression to AIDS in women.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB402)

Sterling T, Strathdee S, Astemborski J, Quinn T, Urban C, McNairn D, Vlahov D
T. Sterling, Johns Hopkins University, 1830 E. Monument Street, Room 444, Baltimore, MD 21287, United States, Tel.: +1 410 614 0922, Fax: +1 410 955 7889, E-mail: tsterls@jhmi.edu

BACKGROUND: Initial HIV-1 plasma RNA level (VL) after seroconversion (SC) predicts progression to AIDS in men; this has not been well-studied in women. Recent studies have demonstrated lower VL in women than men at the time of SC, and sex differences in HIV-1 viral dynamics. We measured plasma VL among all HIV-1 seroconverters enrolled in a longitudinal cohort study of injection drug users (IDU) and correlated the initial VL with the subsequent development of AIDS.

METHODS: 3,380 IDU were enrolled and followed every 6 months between March 1989-December 1998. VL was subsequently quantified for each visit after HIV-1 SC. Inclusion criteria for this study were HIV-1 SC within 12 months of last seronegative visit and before 12/1/97, and > 2 plasma VL's after SC. VL was determined by RT-PCR (Roche).

RESULTS: There were 295 seroconverters, of whom 202 met the inclusion criteria; women were not disproportionately excluded. Although 29/156 (19%) male and 15/46 (33%) female seroconverters progressed to AIDS, time to AIDS did not differ by sex (p = 0.19). Time between SC and 1st VL did not differ by sex (median = 4 mos; p = 0.8). Among male seroconverters, initial median VL was 77,822 copies/ml among those who progressed to AIDS compared to 40,634 copies/ml among those who did not (p = 0.009). Among female seroconverters, initial median VL was 17,149 copies/ml among those who progressed to AIDS compared to 12,043 copies/ml among those who did not (p = 0.21). Initial CD4 did not differ between progressors and nonprogressors among both men and women.

CONCLUSIONS: Initial VL after SC did not predict progression to AIDS in women but did in men; there was no sex difference in time to AIDS. This is consistent with a sex difference in viral dynamics and suggests that these data should be incorporated into treatment guidelines for women.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV-1, Cohort Studies, Longitudinal Studies, Reverse Transcriptase Polymerase Chain Reaction, Adult, Human, Female, Male
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