Seattle Treatment Education Project: STEP Perspective - Volume 4, Number 3 - October 1992
Lori Panther, M.D.

One study of HIV seroconversion rates in a cohort of over 2,000 HIV-positive people projected an estimated 10 to17 percent of the cohort will be AIDS-free at 20 years after seroconversion (Munoz, USA, Session 80). Ongoing study of 562 seroconvertors in the San Francisco City Clinic Cohort notes 135 people who remain AIDS- free at 10 years after seroconversion. Most notable was the range of CD4 counts within the long-term survivor group, with 25 percent having a CD4 count below 200, 50 percent with CD4 between 200 and 500, and 25 percent with CD4 above 500. Laboratory studies of lymphocyte function in the group with CD4 above 500 showed two important findings: their lymphocytes were able to be maintain the ability to be toxic to HIV-infected cells and their CD8 (T suppressor) cells are persistently elevated. Studies of the HIV strains in this group show low viral load and decreased ability of the HIV strains to cause CD4 cell death (Buchbinder, USA, Session 80).

Race and gender. Studies addressing possible differences in progression rates because of race or sex were presented. A study of U.S. blacks noted that, although blacks comprise only 12 percent of the U.S. population, this group makes up a third of AIDS cases in the U.S. A comparison of 320 gay white HIV- positive and 120 gay black HIV-positive people noted a rate of progression to AIDS at four years of 25 percent in the white cohort and18 percent in the black cohort. The rate of CD4 decline was lower in the black cohort compared to the white cohort (Easterbrook, USA, MoC0064). A study of survival analysis among a cohort of HIV-positive people in the United Kingdom was presented. Three quarters of those studied were intravenous drug users, and one third were women. The study found no gender difference in HIV progression in a clinic that also assessed itself as being able to provide the same level of care to all patients in the cohort (Brettle, U.K., MoC0066).

Acute HIV infection. A study of primary (or initial) HIV infection revealed those who had symptomatic primary infection progressed to AIDS faster than those who had asymptomatic infection. A study of over 130 people followed from the time of primary infection showed that 56 percent of symptomatic seroconverters progressed to AIDS at 56 months vs. 20 percent of asymptomatic seroconvertors. Symptomatic infection was more likely to occur in those who had acquired HIV via sexual transmission. Poor prognostic factors for early development of AIDS included low CD4 count at seroconversion and an extended period of seronegativity in the time period from infection to seroconversion (Sinicco, Italy, MoC 0063). Another study of 108 seroconvertors followed for 3.6 years found a four-fold increased risk for development of AIDS if the patient had fever and rash at the time of initial HIV infection (Keet, Netherlands, MoC0085).

In summary, initial immunologic reaction to primary HIV infection may somehow affect the rate of HIV progression. Studies of long- term survivors of HIV infection suggest a number of interrelating factors affecting HIV progression are at work, including the ability of the immune system to maintain a response to HIV infection as well as the biologic aggressiveness of the viral strain. Race and gender alone may not be biologic markers of HIV progression, but those variables may lend themselves as socioeconomic markers for poor access to health care which secondarily predisposes one to HIV progression. The trend toward decreased rate of HIV progression and higher CD4 counts in HIV- positive blacks is intriguing and may indicate a difference in HIV progression relating to genetic differences in immune suppression and other factors.

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