Is the clinical course of HIV-1 changing? Cohort study

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Abstract
Objective: To assess whether the clinical course of HIV infection has changed from 1985 to 1995. Design: Cohort study. Setting: Infectious diseases clinic. Subjects: 285 patients recruited from September 1985 to January 1995 with ≤12 months between the dates of their last seronegative and first seropositive test result and with first follow up visit in the six months after seroconversion and at least 12 months' follow up. Patients were grouped according to the date of seroconversion. Main outcome measures: Time to CD4 cell count of 6 cells/l and clinical outcome defining AIDS; variation in cell count per day between consecutive visits, and ratio between this variation and time from estimated date of seroconversion at each visit. Results: The groups were similar in age, number with acute primary HIV infection, CD4 cell count at intake, and cell count at the beginning of antiretroviral treatment; they differed in sex ratio, risk factors for HIV, probability of CD4 cell decline to 296 nmol/l were independent predictors of poor clinical course. The speed of CD4 cell decline, expressed as cell variation divided by the number of days between consecutive visits, increased with more recent seroconversion (P=0.02). Ratio between the speed of CD4 cell decline and time from estimated date of seroconversion at each visit was also higher in the patients who seroconverted after December 1989. Conclusions: The faster disease progression and the higher speed of CD4 cell decline at early stages in the patients with recently acquired HIV infection suggest changes in the clinical course of HIV infection. Interest in possible changes in the course of HIV infection has recently increased Previous research has shown no clear trend for changes in CD4 cell count by interval after HIV seroconversion Results from a large and heterogeneous cohort of patients who seroconverted between September 1985 and January 1995 showed that the patients who seroconverted after December 1989 had a higher probability of decline in CD4 cell count and progression to AIDS than did patients who had seroconverted before this date The overall rate of decline in CD4 cell count was higher in patients who seroconverted after December 1989; 180 days after seroconversion the rate was highest in those who seroconverted after December 1989, and 360 days after seroconversion it was highest in those who seroconverted after December 1989 and before January 1991 Repeated monitoring within the first months after HIV seroconversion is needed to identify those patients who could benefit from early antiretroviral treatment

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